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Gastrocolic fistula secondary to adenocarcinoma of the transverse colon: a case report.

Vergara-Fernández O, Gutiérrez-Grobe Y, Lavenant-Borja M, Rojas C, Méndez-Sánchez N - J Med Case Rep (2015)

Bottom Line: His colon, stomach and left diaphragm were resected en bloc.Our patient is alive and without any recurrence 5 years after surgery.This is one of the patients with greater survival reported in the medical literature.

View Article: PubMed Central - PubMed

Affiliation: Colorectal Surgery, Medica Sur Clinic and Foundation, Puente de Piedra 150, Col. Toriello Guerra, Mexico City, 14050, Mexico. omarvergara74@hotmail.com.

ABSTRACT

Introduction: Gastrocolic fistula is a rare complication of adenocarcinoma of the colon. Despite radical resections, these patients usually have a poor prognosis with a mean survival of 23 months and long-term survival is rarely reported.

Case presentation: A 48-year-old Latino-American man presented with watery diarrhea, diffuse abdominal pain and weight loss for 3 months. A computed tomography scan revealed a mass in the splenic flexure that had infiltrated his stomach and diaphragm. Panendoscopy and colonoscopy confirmed the presence of a fistula between the distal transverse colon and the stomach, which was secondary to a colon cancer. His colon, stomach and left diaphragm were resected en bloc. A histological examination revealed a moderately differentiated adenocarcinoma of the colon that had infiltrated the full width of the gastric wall with 37 negative lymph nodes and clear surgical margins. Adjuvant chemotherapy with capecitabine and oxaliplatin was administered after surgery. Our patient is alive and without any recurrence 5 years after surgery.

Conclusions: En bloc resection with adjuvant chemotherapy offers the best treatment option for gastrocolic fistulas. This is one of the patients with greater survival reported in the medical literature.

No MeSH data available.


Related in: MedlinePlus

a Gastroscopy image showing an ulcerated mass at the body of the stomach and the opening of a fistula above the mass. b A mass at the splenic flexure of the colon
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Fig2: a Gastroscopy image showing an ulcerated mass at the body of the stomach and the opening of a fistula above the mass. b A mass at the splenic flexure of the colon

Mentions: A computed tomography (CT) scan of his abdomen showed a mass in the splenic flexure of the colon that had infiltrated the greater curvature of the stomach and revealed the presence of a gastrocolic fistula; the mass also involved the left anterolateral region of the diaphragm (Fig. 1). The endoscopy revealed an ulcerated polypoid gastric neoplasm in the greater curvature of the stomach and an ulcerated colonic neoplasm in the splenic flexure of the colon and the distal part of the transverse colon. The largest diameter of the ulcer was 1.4 cm (Fig. 2). Biopsies taken from his stomach and colon revealed a moderately differentiated adenocarcinoma of intestinal type originating from a villous adenoma and a moderately differentiated adenocarcinoma originating from a villous adenoma, respectively. A positron emission tomography (PET) scan performed for staging purposes before surgery suggested involvement of the gastric, hepatic and preaortic lymph nodes (Fig. 3).Fig. 1


Gastrocolic fistula secondary to adenocarcinoma of the transverse colon: a case report.

Vergara-Fernández O, Gutiérrez-Grobe Y, Lavenant-Borja M, Rojas C, Méndez-Sánchez N - J Med Case Rep (2015)

a Gastroscopy image showing an ulcerated mass at the body of the stomach and the opening of a fistula above the mass. b A mass at the splenic flexure of the colon
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4644322&req=5

Fig2: a Gastroscopy image showing an ulcerated mass at the body of the stomach and the opening of a fistula above the mass. b A mass at the splenic flexure of the colon
Mentions: A computed tomography (CT) scan of his abdomen showed a mass in the splenic flexure of the colon that had infiltrated the greater curvature of the stomach and revealed the presence of a gastrocolic fistula; the mass also involved the left anterolateral region of the diaphragm (Fig. 1). The endoscopy revealed an ulcerated polypoid gastric neoplasm in the greater curvature of the stomach and an ulcerated colonic neoplasm in the splenic flexure of the colon and the distal part of the transverse colon. The largest diameter of the ulcer was 1.4 cm (Fig. 2). Biopsies taken from his stomach and colon revealed a moderately differentiated adenocarcinoma of intestinal type originating from a villous adenoma and a moderately differentiated adenocarcinoma originating from a villous adenoma, respectively. A positron emission tomography (PET) scan performed for staging purposes before surgery suggested involvement of the gastric, hepatic and preaortic lymph nodes (Fig. 3).Fig. 1

Bottom Line: His colon, stomach and left diaphragm were resected en bloc.Our patient is alive and without any recurrence 5 years after surgery.This is one of the patients with greater survival reported in the medical literature.

View Article: PubMed Central - PubMed

Affiliation: Colorectal Surgery, Medica Sur Clinic and Foundation, Puente de Piedra 150, Col. Toriello Guerra, Mexico City, 14050, Mexico. omarvergara74@hotmail.com.

ABSTRACT

Introduction: Gastrocolic fistula is a rare complication of adenocarcinoma of the colon. Despite radical resections, these patients usually have a poor prognosis with a mean survival of 23 months and long-term survival is rarely reported.

Case presentation: A 48-year-old Latino-American man presented with watery diarrhea, diffuse abdominal pain and weight loss for 3 months. A computed tomography scan revealed a mass in the splenic flexure that had infiltrated his stomach and diaphragm. Panendoscopy and colonoscopy confirmed the presence of a fistula between the distal transverse colon and the stomach, which was secondary to a colon cancer. His colon, stomach and left diaphragm were resected en bloc. A histological examination revealed a moderately differentiated adenocarcinoma of the colon that had infiltrated the full width of the gastric wall with 37 negative lymph nodes and clear surgical margins. Adjuvant chemotherapy with capecitabine and oxaliplatin was administered after surgery. Our patient is alive and without any recurrence 5 years after surgery.

Conclusions: En bloc resection with adjuvant chemotherapy offers the best treatment option for gastrocolic fistulas. This is one of the patients with greater survival reported in the medical literature.

No MeSH data available.


Related in: MedlinePlus