Malignant Coloduodenal Fistulas-Review of Literature and Case Report

Abstract

Colo-duodenal fistula is an uncommon complication of malignant and inflammatory bowel disease. Presentation varies from upper abdominal pain, feculent vomiting and diarrhea associated with foul eructation's. Occasionally patients presents with gastro-intestinal bleed. The contact of duodenal bile salts with colonic mucosa frequently leads to diarrhea, so also duodenal colonization with colonic pathogens frequently leads to malabsorption and severe foul eructations. The diagnosis is established either by gastrointestinal contrast studies or contrast enhanced C. T. Scan. Gastroduodenoscopy can demonstrate the fistulous communication or direct invasion and it can also be helpful in obtaining a histological diagnosis. Surgical treatment includes Right Radical hemicolectomy combined with Pancreatico duodenectomy in operable patients and Intestinal bypass for inoperable ones.Right Radical hemicolectomy combined with wedge excision of Duodenum is a suitable alternative in select cases. We report an unusual case of locally advanced carcinoma hepatic flexure of colon with direct invasion of duodenum. Extended right radical hemicolectomy with wedge excision of second part of duodenum was done as an alternative to combined radical hemicolectomy with Pancreatico duodenectomy.

Duodenocolic fistula diagnosed by endoscopy: a rare complication of colon cancer

“…Patients with DCF typically present with colicky abdominal pain, intractable diarrhoea, vomiting, malnutrition and weight loss 4 8. As in our case, persistent diarrhoea was the most prominent symptom owing to the colonisation of the duodenum with colonic flora from fecal contamination 8.…”

“…Fistula formation may be due to a benign cause, usually associated with inflammatory diseases such as Crohn's disease,4 tuberculosis,4 gallstone disease5 and occurring as a complication of surgery or radiotherapy 6…”

“…Management of these patients is mainly supportive and directed primarily towards nutritional provision, correction of dehydration and prevention of electrolyte imbalance 3. Surgical palliation with ileotransverse colostomy with gastrojejunostomy has been reported to successfully relieve symptoms of malignant DCF 4 7 17 18. However, survival in these patients is usually less than a year 4 19…”

“…Surgical palliation with ileotransverse colostomy with gastrojejunostomy has been reported to successfully relieve symptoms of malignant DCF 4 7 17 18. However, survival in these patients is usually less than a year 4 19Learning points

Malignant duodenocolic fistula (DCF) is an unusual complication of colon cancer.

It commonly presents with non-specific gastrointestinal symptoms such as vomiting, diarrhoea and abdominal pain.

Diagnosis may require endoscopic interventions for tissue sampling and histologic confirmation to facilitate prompt curative surgical planning.

For patients with advanced lesions, palliative surgery may offer the best solution, often relieving bothersome symptoms of malignant DCF and allowing nutritional provision.

…”

Malignant Duodeno-Colic Fistula: A Rare Complication of Colorectal Cancer

“…The anatomical complexity of duodeno-pancreatic area poses a challenge to surgical ap proach and the situation can be further compounded by local invasion of major vessels. Right hemicolectomy with either partial duodenenctomy and primary closure of duodenal wall defect or the use of jejeunal loop have been proposed as surgical procedures with curative intent [8,9]. In Japan, Izumi examined 34 cases of MDCF treated by en bloc pancreaticoduodenectomy and reported their survival rate of 7 days to 4 years (median=10 months) [10].…”