Gastrojejunocolic fistula after gastrojejunostomy in Ayder referral hospital Northern Ethiopia: A report of two cases

Abstract

BackgroundGastrojejunocolic fistula (GJCF) is a late and severe complication of a stomal ulcer after gastrojejunostomy, which develops as a result of inadequate resection of stomach or incomplete vagotomy. The occurrence of perforation in a GJCF is even more a rare complication because long evolution time or latent period is required for its appearance. Patients with this condition usually present with diarrhea, weight loss, feculent vomiting, under-nutrition and features of peritonitis that require immediate surgical intervention.Case presentationWe described two cases of gastrojejunocolic fistula in men aged 60 and 40, first cases of gastrojejunocolic fistula seen in our referral hospital and in the whole region following more than a decade after gastrojejunostomy. Both patients initially presented with watery diarrhea, vomiting of fecal materials, poor appetite and weight loss. Upper GI series or barium enema studies allowed a conclusive diagnosis to be made. Both patients underwent one-stage en bloc resection, and their postoperative course and outcome was one cure and one death.ConclusionAs it is rare phenomenon, high clinical suspicion is very important in the diagnosis of GJCF on patients who manifest with chronic diarrhea, vomiting of fecal matter, abdominal pain and features of malnutrition. Careful preoperative preparation is mandatory before any type of surgical procedure is carried out. Pre-operative nutritional status should be evaluated in patients undergoing corrective surgery. Adequate resection of the stomach after Gastrojejunostomy and complete vagotomy is important to prevention development of GJCF.

Inhibiting the proton pump: mechanisms, benefits, harms, and questions

“…The techniques used included partial gastrectomy with anastomosis to the duodenum (Billroth I), gastrectomy with gastrojejunostomy (Billroth II), Roux-en-Y bypass [1], and highly-selective vagotomy with or without pyloroplasty [2, 3]. The results were often good, but at the cost of unwanted effects [4, 5], including dumping syndrome [6], stomal ulceration [7], gastrojejunocolic fistulae [8], and a risk of cancer in the gastric stump [9]. …”