Unusual case of gastro jejuno-colic fistula with perforation: a rare case report

Abstract

Gastrojejunocolic fistula (GJF) is a late and very rare complication of gastroenterostomy performed for recurrent peptic ulcer disease. The occurrence of perforation in a GJF 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. Herewith we report a case of 60 year old male with perforation in a gastrojejunocolic fistula and its management.

Acute perforation in a gastrojejunocolic fistula after a laparascopic Roux-en-Y gastric bypass: case report

“…A chronic jejunocolic fistula after LRYGB was described by Fronza et al [ 4 ]. Sundeep et al published a case report of an acute perforation in a gastrojejunocolic fistula [ 5 ]. However, this complication occured after a gastroenterostomy performed for recurrent peptic ulcer disease.…”

“…Possible symptoms in a gastrojejunocolic fistula are fecal eructation, chronic diarrhea, malnutrition and weight loss [ 3 – 5 ]. In our case, chronic diarrhea, malnutrition and weight loss were reported.…”

“…Sundeep et al described the case of an acute perforation in a gastrojejunocolic fistula after a gastroenterostomy performed for recurrent peptic ulcer disease [ 5 ]. In this case, an ulcer at the gastro-enterostomy had extended to the transverse colon.…”

“…The fistula was dissected circumferentially and a wide excision of the ulcer and involved colon was performed during an open revision of the gastrojejunostomy. Bowel continuity was recontructed with a colocolostomy, a Roux-en-Y gastrojejunostomy with feeding jejunostomy [ 5 ].…”

Perforation of the Anastomotic Line Post-Truncal Vagotomy and Gastrojejunostomy

“…It is diagnosed using barium studies (95-100% accurate), computed tomography scan of the abdomen or endoscopy. Initially, a 2-3 staged operation (Lahey's procedure -comprising a colostomy, resection of the fistula, and colostomy closure) was performed; however, nowadays, due to the advent of better enteral support (total parenteral or total enteral nutrition) a single-staged procedure may be performed with decreased morbidity and mortality [9,10]. Takemura et al have concluded that today, laparoscopic-assisted one-stage en bloc resection may be feasible for patients with GJC fistula [11].…”