Diaconescu M R, Costea I, Glod M, Ceobanu M, Bulimar V, Ciolpan Catalina
Facultatea de Medicina Dentara, Universitatea de Medicina şi Farmacie "Gr.T. Popa", Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2006 Oct-Dec;110(4):899-904.
Gastrocolic fistula (GCF) is a rare and severe lesion appearing traditionally as a complication of inadequate gastric surgery or in the context of stomach or colon malignancy, but actually arising from many different gastrointestinal conditions. Three patients with GCF, admitted and operated in our clinic, are presented. The first case, a man aged 36 years, was a classical one, with a G(jejuno)CF appearing three years after a gastrectomy with Reichel-Polya reconstruction for duodenal ulcer, resolved by a "revision gastrectomy" en block with segmental resection of the jejunum and transverse colon. The second case, also a man aged 43 years, presented a spontaneous GCF determined by a gastric carcinoma, that required an en block enlarged gastro-colectomy. The last case, a 61 year-old woman, presented three weeks after an emergency concomitant cholecystectomy and appendicectomy, with clinical manifestation suggesting a subphrenic abscess. Although a contrast-enhanced CT revealed a communication between the great curvature of the stomach and the splenic flexure of the colon, no fistula was found at laparotomy (spontaneous healing?). However, the terminal ileum and ascending colon had a suggestive appearance of Crohn's disease (confirmed by pathology) and a right colectomy was done. Excepting the rare situation of spontaneous or after medical treatment healing, the mainstay therapy of GCF is the case-adapted surgery.
胃结肠瘘（GCF）是一种罕见且严重的病变，传统上表现为胃手术不当的并发症或在胃或结肠恶性肿瘤的情况下出现，但实际上它可由许多不同的胃肠道疾病引起。本文介绍了在我们诊所收治并接受手术的3例胃结肠瘘患者。第一例患者为一名36岁男性，是典型病例，在因十二指肠溃疡行胃切除Reichel-Polya重建术后3年出现胃空肠结肠瘘，通过“修正性胃切除术”整块切除空肠和横结肠节段得以解决。第二例患者也是一名43岁男性，因胃癌导致自发性胃结肠瘘，需要进行整块扩大胃结肠切除术。最后一例患者是一名61岁女性，在急诊同期行胆囊切除术和阑尾切除术后3周出现临床表现提示膈下脓肿。尽管增强CT显示胃大弯与结肠脾曲之间存在连通，但剖腹手术时未发现瘘管（自发愈合？）。然而，末端回肠和升结肠有克罗恩病的可疑表现（病理证实），遂行右半结肠切除术。除了罕见的自发愈合或经药物治疗后愈合的情况外，胃结肠瘘的主要治疗方法是根据具体病例进行手术。
