Palliative treatment of malignant duodenoenteric fistulas

M, Zer; Wolloch, Y; Lombrozo, R; Dintsman, M

doi:10.1007/bf02393113

Cited by 8 publications

(4 citation statements)

References 7 publications

(23 reference statements)

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“…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. Palliative surgery is indicated in extensive retroperitoneal involvement of the primary tumor and includes Ileotransverse anastomoses along with gastrojejunostomy which relieves the symptoms of malignant duodeno-colic fistula [32]. Some authors advise utilizing the exclusion bypass principle in specially selected patients [26].…”

Section: Discussionmentioning

confidence: 99%

Malignant Coloduodenal Fistulas-Review of Literature and Case Report

Majeed

Agarwal

Shilpa

et al. 2011

Indian J Surg Oncol

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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.

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Section: Discussionmentioning

confidence: 99%

Malignant Coloduodenal Fistulas-Review of Literature and Case Report

Majeed

Agarwal

Shilpa

et al. 2011

Indian J Surg Oncol

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“…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…”

Section: Discussionmentioning

confidence: 99%

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

Timbol

Djajakusuma

et al. 2017

BMJ Case Reports

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Duodenocolic fistula (DCF) is a rare complication of colon cancer with only 70 cases reported since its first description in 1862. Owing to its rarity, current knowledge on DCF still relies on single case reports. We present 2 cases of DCF from a hepatic flexure adenocarcinoma demonstrated initially by endoscopy. 2 adult male patients were admitted due to a 2-3-month history of right-upper quadrant pain, vomiting, diarrhoea and a palpable right upper quadrant mass. In both cases, a circumferential, friable mass was noted on upper endoscopy at the second portion of the duodenum, leading to the ascending colon. A similar-looking lesion was also noted on colonoscopy. Biopsies in both cases confirmed colonic adenocarcinoma. Owing to the advanced nature of the disease, en bloc resection was not achieved. Instead, tube jejunostomy and loop ileostomy were created. Both patients were discharged tolerating feeding with improvement in symptoms.

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“…Palliative surgery is indicated when there is extensive local infiltration with retroperitoneal extension, extension to the major vessels, and distant metastasis. An ileotransverse anastomosis combined with a gastrojejunostomy may be performed in selected patients with advanced disease to relieve the obstruction and defunction the fistula [13]. Bypassing the fistula also minimizes bacterial contamination of the upper gastrointestinal tract and associated malabsorption.…”

Section: Discussionmentioning

confidence: 99%

Palliative end ileostomy and gastrojejunostomy for a metastatic distal transverse colonic malignancy complicated by a proximal duodenocolic fistula: a case report

et al. 2017

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BackgroundFistulae between the colon and upper gastrointestinal tract are distressing and uncommon complications of malignancies involving this region. We report a case of a middle-aged man with a locally advanced and metastatic distal transverse colon malignancy who presented with a duodenocolic fistula proximal to the primary tumor and underwent palliative surgery.Case presentationA 50-year-old Sri Lankan man presented to our hospital with a history of feculent vomiting of 1 week’s duration preceded by worsening constipation and abdominal fullness of 2 months’ duration. He also complained of anorexia and significant weight loss over the previous month. His physical examination was unremarkable except for his wasted appearance. Flexible sigmoidoscopy done at his local hospital had not revealed any abnormality in the left colon. Gastroduodenoscopy did not reveal fecal matter or any mucosal abnormalities in the stomach or duodenum. An abdominal contrast-enhanced computed tomographic scan showed a mid-to-distal transverse colonic tumor with a duodenocolic fistula proximal to the primary lesion. At laparotomy, he was found to have an unresectable, locally advanced mid transverse colon tumor with diffuse peritoneal and mesenteric deposits and mild ascites. Palliative end ileostomy and gastrojejunostomy were performed before closure. Histology from the malignant deposits revealed a well-differentiated adenocarcinoma. He made an uneventful recovery with good symptomatic relief.ConclusionsMalignant gastric or duodenocolic fistulae are uncommon complications of locally advanced colonic malignancies with direct invasion to the stomach or duodenum. Although the characteristic clinical presentation of feculent vomiting suggests the diagnosis, cross-sectional imaging is confirmative in addition to staging the disease. Management is guided by disease stage, nutritional status, and the general condition of the patient and ranges from extensive bowel resection including the fistula to palliative options.

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Palliative treatment of malignant duodenoenteric fistulas

Cited by 8 publications

References 7 publications

Malignant Coloduodenal Fistulas-Review of Literature and Case Report

Malignant Coloduodenal Fistulas-Review of Literature and Case Report

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

Palliative end ileostomy and gastrojejunostomy for a metastatic distal transverse colonic malignancy complicated by a proximal duodenocolic fistula: a case report

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