Mainali Sayara, Jha Aditya Kumar, Keshari Suraj, Gnyawali Arun, Laudari Uttam, Malla Bala Ram
Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
Department of Radiology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
Int J Surg Case Rep. 2024 Oct;123:110303. doi: 10.1016/j.ijscr.2024.110303. Epub 2024 Sep 18.
Gastrojejunocolic fistula is an abnormal communication between a portion of the stomach, jejunum and the transverse colon. Gastrojejunocolic (GJC) fistula is an outcome resulting from the surgical procedures of gastrectomy and gastrojejunostomy used to address recurrent peptic ulcer disease and secondary to malignancy. Patients present with the typical symptoms of diarrhea, belching with fecal odor or fecal vomiting and weight loss. Gastrojejunocolic fistula is a rare complication of adenocarcinoma of the colon. En-bloc resection followed by adjuvant chemotherapy helps in managing GJC fistula secondary to adenocarcinoma of colon.
A 55-year-old male from a rural area presented with a two months history of black stool, vomiting, loose stools, and abdominal pain. He had a history of significant weight loss, chronic alcohol use, and smoking. Investigations revealed anemia, hyponatremia, hypoalbuminemia, and a large exophytic mass on Contrast-Enhanced Computed Tomography (CECT), suggestive of gastrojejunocolic fistula from a carcinoma. Upper gastrointestinal endoscopy showed an ulcero-proliferative growth with high-grade dysplasia. Biochemical tests revealed elevated carcinoembryonic antigen (CEA) levels. The patient underwent surgery for en bloc resection of the stomach, jejunum and transverse colon. Histology confirmed adenocarcinoma of colon with TNM stage IIIC. Post-operative gastrocutaneous fistula was managed conservatively and colostomy reversal was done for prolapse colostomy. He has completed the chemotherapy Capecitabine-Oxaliplatin (CAPOX) regimen. He is doing well and under follow-up for six months post-surgery.
Gastrojejunocolic fistula secondary to carcinoma is a rare finding. Gastrojejunocolic fistula originate from the direct spread of the tumor across the gastrocolic omentum or an ulcer in the tumor could trigger an inflammatory peritoneal response, resulting in adhesion and the formation of a fistula.
This case highlights the successful management of a gastrojejunocolic fistula secondary to adenocarcinoma of colon through three stage surgery; diverting stoma, en bloc resection, colostomy reversal surgery along with chemotherapy. Despite post-operative complications, including a gastro-cutaneous fistula and prolapsed colostomy, the patient responded well to treatment. Multidisciplinary approaches and careful monitoring are essential in resource-limited settings for improved patient outcomes.
胃空肠结肠瘘是胃、空肠与横结肠之间的异常通道。胃空肠结肠瘘是胃切除术和胃空肠吻合术等外科手术治疗复发性消化性溃疡疾病及继发于恶性肿瘤后的一种结果。患者表现出腹泻、粪便气味呃逆或粪便样呕吐以及体重减轻等典型症状。胃空肠结肠瘘是结肠癌的一种罕见并发症。整块切除并辅以辅助化疗有助于处理继发于结肠癌的胃空肠结肠瘘。
一名来自农村地区的55岁男性，有两个月黑便、呕吐、腹泻和腹痛病史。他有明显体重减轻、长期酗酒和吸烟史。检查发现贫血、低钠血症、低白蛋白血症，对比增强计算机断层扫描（CECT）显示一个大的外生性肿块，提示癌性胃空肠结肠瘘。上消化道内镜检查显示溃疡增生性肿物伴高级别异型增生。生化检查显示癌胚抗原（CEA）水平升高。患者接受了胃、空肠和横结肠整块切除术。组织学证实为TNM IIIC期结肠癌。术后胃皮肤瘘采用保守治疗，脱垂结肠造口术进行结肠造口还纳。他已完成了卡培他滨 - 奥沙利铂（CAPOX）化疗方案。他术后恢复良好，术后六个月一直在接受随访。
继发于癌症的胃空肠结肠瘘是一种罕见发现。胃空肠结肠瘘起源于肿瘤通过胃结肠网膜的直接蔓延，或者肿瘤中的溃疡可引发炎症性腹膜反应，导致粘连并形成瘘管。
本病例强调了通过三期手术成功处理继发于结肠癌的胃空肠结肠瘘；即转流造口、整块切除、结肠造口还纳手术以及化疗。尽管术后出现了包括胃皮肤瘘和脱垂结肠造口术等并发症，但患者对治疗反应良好。在资源有限的环境中，多学科方法和仔细监测对于改善患者预后至关重要。
