Leone Sara, Barabino Matteo, Marsetti Maurizio, Rampinelli Luca, Arnoldi Daniela, Opocher Enrico
Divisione di Chirurgia Generale, Azienda Ospedaliera Bolognini Seriate, Via Paderno 21, 24068 Seriate, BG.
Chir Ital. 2003 Nov-Dec;55(6):923-8.
Delayed gastrojejunocolic fistulas in patients previously operated for gastric cancer are often caused by local recurrence of the tumour. We present two cases of delayed gastrojejunocolic fistula without neoplastic recurrence. Both patients had been operated for adenocarcinoma several months earlier; a gastric Billroth 2 resection was performed in both cases. The first patient arrived at our hospital for chest pain, dyspepsia, weight loss, vomiting and diarrhoea. Blood tests showed low levels of vitamin B, proteins and cholesterol. The second patient was admitted for lipothymia, hyporexia, proctorrhagia, diarrhoea and weight loss. Blood tests showed macrocytic anaemia and hypoproteinaemia. The radiological and endoscopic examinations revealed a gastrojejunocolic fistula in both cases. Since gastrojejunocolic fistulas are rarely resolved by conservative treatment, we performed a gastric resection with a histological examination to exclude tumour recurrence in both patients. The aetiopathogenesis of gastrojejunocolic fistulas is unknown. It is conceivable that some agents (such as bile) may damage a mucosa that has been weakened by nutritional deficiency and/or postsurgical microvascular damage. Early and delayed gastrojejunocolic fistulas present the same clinical manifestations, namely, diarrhoea, abdominal pain, weight loss and hypoproteinaemia.
既往接受过胃癌手术的患者发生延迟性胃空肠结肠瘘，往往是由肿瘤局部复发引起的。我们报告两例无肿瘤复发的延迟性胃空肠结肠瘘病例。两名患者均在数月前接受了腺癌手术；两例均行胃毕Ⅱ式切除术。首例患者因胸痛、消化不良、体重减轻、呕吐及腹泻前来我院就诊。血液检查显示维生素B、蛋白质及胆固醇水平较低。第二例患者因晕厥、食欲减退、直肠出血、腹泻及体重减轻入院。血液检查显示大细胞性贫血及低蛋白血症。影像学及内镜检查在两例中均发现胃空肠结肠瘘。由于胃空肠结肠瘘很少能通过保守治疗治愈，我们对两名患者均进行了胃切除术及组织学检查以排除肿瘤复发。胃空肠结肠瘘的发病机制尚不清楚。可以想象，某些因素（如胆汁）可能会损害因营养缺乏和/或术后微血管损伤而变得脆弱的黏膜。早期和延迟性胃空肠结肠瘘具有相同的临床表现，即腹泻、腹痛、体重减轻及低蛋白血症。
