Malignant duodenocolic fistula: Report of a case and considerations for operative management

Abstract

Malignant duodenocolic fistula is a rare complication of gastrointestinal malignancy. We present herein the case of a 34-year-old female in whom a large duodenocolic fistula was caused by advanced transverse colonic carcinoma. Right hemicolectomy combined with pancreaticoduodenectomy enabled en bloc resection of the tumor, and the patient has been free of disease for 1 year and 8 months postoperatively. A review of the international literature, including 33 cases reported in Japan, indicates that if the disease is curable, the treatment of choice is right hemicolectomy with pancreaticoduodenectomy, whereas if it is not curable but locally resectable, the best palliation appears to be right hemicolectomy with partial duodenectomy to include the fistulous tract. Dehiscence of the duodenal wound closure associated with partial duodenectomy can be prevented by using the mucosal or serosal patch techniques with intestinal loops. These therapeutic principles are also applicable for colonic carcinoma which massively involves the duodenum without fistula formation.

En bloc pancreaticoduodenectomy and right hemicolectomy to treat locally advanced right colon cancer: report of three cases

“…Sometimes, diarrhea may indicate a duodenocolic fistula (9,10) . Clinical examination may demonstrate a right upper quadrant mass, as observed in case 2 (12) . Computed tomography may sometimes show a hypodense mass in which the adjacent organs are involved, as in the third case of this study (8,(12)(13) .…”

“…Clinical examination may demonstrate a right upper quadrant mass, as observed in case 2 (12) . Computed tomography may sometimes show a hypodense mass in which the adjacent organs are involved, as in the third case of this study (8,(12)(13) . More rarely, preoperative radiological examination may show no locoregional invasion, but invasion of neighboring organs is diagnosed upon intraoperative evaluation, as we observed in case 2.…”

“…Locally advanced cancer of the right colon that adheres to the proximal duodenum or head of the pancreas presents a challenge, even for skilled surgeons. This situation may require complex and difficult surgical resolution that involves en bloc pancreaticoduodenectomy plus right hemicolectomy (8)(9)(10)(11)(12)(13)(14) . Since few reports have been published regarding this uncommon clinical situation, the present study reports on three cases of en bloc pancreaticoduodenectomy plus right hemicolectomy for locally advanced right colon cancer.…”

Malignant Coloduodenal Fistulas-Review of Literature and Case Report

“…There are various curative operations reported, all of which include a right hemicolectomy. Izumi reviewed a series of 34 cases of malignant colo-duodenal fistulae in Japan, and their survival with en bloc pancreatico duodenectomy ranged from 7 days to 4 years (median=10 months) [28]. Chang treated 20 of his patients with right hemicolectomy with partial duodenectomy and primary closure of the duodenal wall defect [29].…”

“…Colectomy with partial duodenectomy and primary duodenal closure of the duodenal defect has been reported with minimal duodenal involvement [30,31]. Highest survival rates have been reported when Colectomy is combined with pancreatico -duodenectomy (Whipple's Procedure) due to resection of the tumor and the fistula as well as adequate regional lymph node dissection [28]. However Colectomy combined with segmental duodenal resection and primary end to end anastomosis is a useful alternative in select cases, not compromising the oncologic clearance.…”