Malignant duodenocolic fistula

Abstract

Two patients had duodenocolic fistulas, each following a carcinoma of the colon in the area of the hepatic flexure that had perforated into the duodenum. The first patient was treated by a radical pancreatoduodenectomy with right colectomy; the second by subtotal colectomy with excision of the duodenal wall and suture. Both patients are alive and without evidence of recurrent disease. In addition, the first patient had two other primary carcinomas, in the cecum and in the stomach, and the second patient had another primary in the sigmoid. The definitive procedure had to be adjusted to encompass all lesions. The radical operation in one stage seems to be the preferred procedure and certainly is most satisfactory as a cancer operation. Our patient treated by this procedure has survived more than 11 years. An intestinal fistula related to colonic carcinoma, evan though rare, should not be considered as a separate entity. Treatment of the cancer with an en-bloc resection of the communicating organs should be employed if possible.

Malignant Duodenocolic Fistula- Case Report of Rare Complication of Colonic Cancer Treated by Multivisceral Resection

“…Vieta et al [13] in their study shown that 46% of their cases survived at least 2.5 yrs after right hemicolectomy with pancreaticoduodenectomy with longest survivior reported alive 26 yrs after the operation. In Japan, Izumi examined 34 cases od malignant duodenocolic fistula treated by en bloc pancreaticoduodenectomy and reported their survival rate of 7 days to 4 years (median=10 months) [14].…”

Palliative treatment of malignant duodenoenteric fistulas

“…Gallagher [7] reported 2 cases of "extended right hemicolectomy" in which en bloc resection of the tumor was successfully accomplished by performing a combined right hemicolectomy and Whipple operation. Vieta et al [8] reported 2 similar cases in which there was long-term survival, and they advocated "extensive and courageous surgery." Unfortunately, only sporadic patients are amendable to such extensive resections [2].…”

“…Radical resection of the colonic tumor together with the involved adjacent structures is, beyond doubt, the treatment of choice, when feasible in these cases [ 1,2,7,8]. Gallagher [7] reported 2 cases of "extended right hemicolectomy" in which en bloc resection of the tumor was successfully accomplished by performing a combined right hemicolectomy and Whipple operation.…”