Shweta Bhatnagar, DO, Alexandra Davies, DO, Iftiker Ahmad, MD McLaren Greater Lansing, Lansing, MI
Introduction: Gastrocolic fistula (GCF) is pathological communication between the stomach and transverse colon. Even though presentation is rare, it occurs mostly in the setting of gastric or colonic malignancy. It also appears as a complications of severe peptic ulcer disease (PUD), Crohn's disease, extensive steroid and NSAID use.
Case Description/Methods: We present a case of a 56-year-old female with a history of previous Roux-en-Y gastric bypass surgery in 2006 who presented to emergency department with a 6-month history of severe abdominal pain nausea, hematemesis, profuse diarrhea, and weight loss. Patient endorsed significant weakness and inability to complete activities of daily living. CT abdomen on presentation showed a gastrocolic fistula. EGD findings included a normal esophagus, normal stomach mucosa and a large adherent clot in the proximal jejunum that was removed with aggressive water jet and cold snare. After removal of during clot, 2 visible vessels were appreciated most proximally in jejunum. A total of 8 cc of epinephrine was injected into the surrounding area. After multiple attempts of gold probe cautery, hemostasis was achieved. A small portion of the adherent clot was not able to be removed and it encompassed 70% of the mucosal surface. Repeat EGD was completed to 48 hours after initial EGD that showed normal esophageal mucosa, normal stomach mucosa, clean-based jejunal ulcer with healed eschar from prior gold probe cautery with no evidence of visible vessels. To the right of the ulcer, gastroscope was advanced through gastrocolic fistula at 45 cm from incisors to the transverse colon. Transverse colon mucosa appeared healthy. Small bowel follow-through completed few days after confirmed GCF. Gastric lumen morphology compatible with gastric bypass. Surgical evaluation was completed. Due to short gut syndrome and poor nutrition, patient was placed on TPN until surgical repair. Currently being followed in the outpatient setting with surgery and primary care.
Discussion: Pharmacological treatment with PPI was initiated. Several treatment modalities exist, the most widely used which is surgical resection of the fistula. This case highlights formation of GCF in the setting of severe PUD as highlighted in the EGD findings.
Shweta Bhatnagar indicated no relevant financial relationships.
Alexandra Davies indicated no relevant financial relationships.
Iftiker Ahmad indicated no relevant financial relationships.
Shweta Bhatnagar, DO, Alexandra Davies, DO, Iftiker Ahmad, MD. P1387 - Findings of Gastrocolic Fistula in a Middle-Aged Female, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.