A case report on multidisciplinary approach towards management of gastrojejunocolic fistula secondary to adenocarcinoma of the colon.

INTRODUCTION

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.

CASE RESENTATION

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.

DISCUSSION

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.

CONCLUSION

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.