Formation of Gastrocolic Fistula During Treatment for Peptic Ulcer

Abstract

We report a case of gastrocolic fistula (GCF) caused by a gastric ulcer and rare endoscopic findings indicating the early stages of GCF formation. The patient was a 58-year-old man who was hospitalized with upper abdominal pain. He was diagnosed as having a gastric ulcer, and was prescribed a proton pump inhibitor (PPI), but did not comply with the medication. One year later, he was again referred with recurrent abdominal pain. Endoscopic examination showed what appeared to be a portion of exposed colonic wall located in the center of an active gastric ulcer, and repeated endoscopy after PPI treatment for 8 days demonstrated a typical GCF. A preoperative diagnosis of GCF was made, and the patient underwent wide gastrectomy with partial resection of the transverse colon.

A case of a bleeding benign gastrocolic fistula in 2014

“…The mainstay treatment of gastrocolic fistulae has classically been surgery, consisting of a distal gastrectomy with hemicolectomy. 10 En-bloc resection of the fistula with primary gastrointestinal reconstruction is recommended as opposed to local fistula resection due to the decreased incidence of recurrence. 8 Due to the nutritionally depleted status these patients usually present in, there is also a role for pre-operative optimization of nutrition status, with several centres advocating peri-operative nutritional support with TPN and bowel rest.…”

“…Recently, reports of successful non-surgical management of gastrocolic fistulas related to NSAID related gastric ulcers have emerged. 10 This consists of ceasing the use of NSAIDs or steroids and commencing a H2-antagonist, with consideration made for TPN. 8 Successful closure of the fistula was noted, and no recurrences occurred in the short term.…”