Unusual causes of gastrocolic fistula

Abstract

Abstract. 1. Three cases of gastrocolic fistula of unusual cause are presented. These include one patient each with carcinoma of the left kidney, gastric lymphoma, and granulomatous colitis.2. The relationships between the kidneys and gastrointestinal tract are illustrated by a cadaveric crosssection.3. The wide variety of diseases resulting in gastrocolic fistula is discussed.4. Careful fluoroscopic and radiographic study may be necessary to detect the site of the fistula and to identify its cause.Key words: Fistula, gastrocolic Gastrointestinal tract, abnormalities.Carcinoma of the stomach or colon is certainly the most common cause of gastrocolic fistula [1 5]. Gastric ulcer is the leading cause of benign gastrocolic fistula, particularly in patients being treated with antiinflammatory agents such as steroids or acetylsalicylic acid [6]. Recently, we have seen three patients with gastrocolic fistula due to unusual causes. The purpose of this report is to stress the wide variety of lesions which must be considered in the differential diagnosis of gastrocolic fistula and to illustrate some of the anatomic relationships in the left upper quadrant.pyelography, retrograde pyelography, and angiography showed a non-functioning kidney with obstruction of the left ureter and renal artery. At surgery there was a large mass involving the kidney with infiltration of the vessels and retroperitoneal tissues. A biopsy showed renal carcinoma, but the mass could not be resected. One year later the patient presented with feculent vomiting. The plain film of the abdomen showed a mass in the left upper quadrant indenting the greater curvature of the stomach. A barium enema examination showed marked irregularity and narrowing of the distal portion of the transverse colon in the region of the splenic flexure with a large fistulous communication with the stomach (Fig. 1 A).Comment. This patient developed a gastrocolic fistula secondary to carcinoma of the left kidney. It is generally recognized that mass lesions in the kidneys may produce large filling defects in various parts of the gastrointestinal tract. The relationships between the kidneys and gastrointestinal tract have recently been reviewed by Meyers [7]. Reno-alimentary fistulae may result from communication of the right kidney with the duodenum or the left kidney with the splenic flexure. The relationships between the kidneys and the gastrointestinal tract are illustrated in the anatomic cross-section in Figure 1 B. Rarely, renal disease may result in fistulae to the stomach, small bowel, appendix, or rectum [8]. Amlicke et al. [2] described a gastrocolic fistula in a patient who had received abdominal irradiation for carcinoma of the kidney. However, we have seen no previous reports of a gastrocolic fistula due to growth of a renal carcinoma as occurred in this patient. Case Reports Patient 1This 47-year-old man was investigated for back pain and a mass in the left flank. Radiologic investigation, including intravenous A 60-year-old female was admitted to the hospital for...

Endoscopic management of duodeno-ileal fistula secondary to diffuse B-cell lymphoma

“…A 2005 review of the literature concluded that <20 entero-entero fistulae secondary to lymphoma had been reported primarily treated surgically [ 6 ]. These intra-abdominal internal lymphomatous fistulae are more commonly jejuno-colic or gastro-colic [ 6 , 7 ].…”