J Gastrointest Surg (2014) 18:2230–2231 DOI 10.1007/s11605-014-2665-3
GI IMAGE
Gastrocolic Fistula: A Rare Sequela of Colonic Adenocarcinoma Samuel Harkin & Sivakumar Gananadha
Received: 10 September 2014 / Accepted: 19 September 2014 / Published online: 8 October 2014 # 2014 The Society for Surgery of the Alimentary Tract
Keywords Gastrocolic fistula . Colonic adenocarcinoma . Feculent vomiting
Case Presentation The case presented is that of a 51-year-old female with a 3month history of worsening weight loss, dyspepsia and episodes of intractable feculent vomiting. Her bowel motions were absent for the preceding 2 weeks following an episode of diarrhoea. Her medical co morbidity included longstanding hypertension. Surgical history was limited to three caesarean sections. Family history included anal cancer in her father and ovarian cancer in her mother. Physical examination revealed a vague fullness of the left upper quadrant of the abdomen. Abdominal ultrasound revealed a left upper quadrant soft tissue mass medial to the left kidney, and subsequent abdominal computerized tomography (CT) with oral contrast displayed marked concentric thickening of the wall of the splenic flexure over a length of 7 cm, with invasion of the stomach and more distant colon, and egression of oral contrast into the colonic lumen from the gastric lumen, consistent with a gastrocolic fistula (Fig. 1). Gastroscopy demonstrated a malignant-appearing ulcer in the greater curvature of the stomach, with liquid faeces within the stomach confirming the presence of a gastrocolic fistula. There was no evidence of involvement of the pancreas or spleen. Initial laboratory examination revealed a carcinoembryonic androgen (CEA) of S. Harkin (*) Australian National University Medical School, Hospital Road, Garran, Australian Capital Territory 2605, Australia e-mail: [email protected] S. Gananadha Upper GI/HPB Unit, Department of Surgery, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory 2605, Australia
80 μg/L (
GI IMAGE
Gastrocolic Fistula: A Rare Sequela of Colonic Adenocarcinoma Samuel Harkin & Sivakumar Gananadha
Received: 10 September 2014 / Accepted: 19 September 2014 / Published online: 8 October 2014 # 2014 The Society for Surgery of the Alimentary Tract
Keywords Gastrocolic fistula . Colonic adenocarcinoma . Feculent vomiting
Case Presentation The case presented is that of a 51-year-old female with a 3month history of worsening weight loss, dyspepsia and episodes of intractable feculent vomiting. Her bowel motions were absent for the preceding 2 weeks following an episode of diarrhoea. Her medical co morbidity included longstanding hypertension. Surgical history was limited to three caesarean sections. Family history included anal cancer in her father and ovarian cancer in her mother. Physical examination revealed a vague fullness of the left upper quadrant of the abdomen. Abdominal ultrasound revealed a left upper quadrant soft tissue mass medial to the left kidney, and subsequent abdominal computerized tomography (CT) with oral contrast displayed marked concentric thickening of the wall of the splenic flexure over a length of 7 cm, with invasion of the stomach and more distant colon, and egression of oral contrast into the colonic lumen from the gastric lumen, consistent with a gastrocolic fistula (Fig. 1). Gastroscopy demonstrated a malignant-appearing ulcer in the greater curvature of the stomach, with liquid faeces within the stomach confirming the presence of a gastrocolic fistula. There was no evidence of involvement of the pancreas or spleen. Initial laboratory examination revealed a carcinoembryonic androgen (CEA) of S. Harkin (*) Australian National University Medical School, Hospital Road, Garran, Australian Capital Territory 2605, Australia e-mail: [email protected] S. Gananadha Upper GI/HPB Unit, Department of Surgery, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory 2605, Australia
80 μg/L (
