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Highlights • Differentiating giant colonic diverticulum and gastrocolic fistula with similar clinical courses may necessitate multiple investigations. • Symptoms that have been present from childhood may be related to congenital etiology. • Because of the risk of colonic closure breakdown and the possibility of recurrence of GCD, colectomy seems to be the best option., Introduction Giant transverse colonic diverticula are a rare case of giant colonic diverticulum (GCD). Instead of being asymptomatic, bleeding, inflammation, and perforation may result in fistula formation and require surgery. This type of diverticulum is thought to be closely related to the gastrocolic fistula (GCF). Presentation of case We report a 26-year-old female presenting severe abdominal pain accompanied by nausea and vomiting and a history of constipation since childhood. The patient felt a mass around the epigastric region and extends to the right hypochondrium. Enema contrast examination showed a large diverticulum in the transverse colon. CT scan revealed a 21.4 × 8.4 cm structure with air-filled structures visible from the transverse colon filled with contrast material, suggesting a possible gastrocolic fistula. Resection was performed on the diverticulum and 20 cm in length of the transverse colon, followed by side-to-side anastomosis. Histopathological findings were type III GCD. The patient was discharged without complications 1 week later. Discussion Giant diverticulum is characterized by a diverticulum with 4 cm or more in length. Our case was a diverticulum from the central portion of the transverse colon with 25 × 9 × 3 cm in length and type III GCD. Resection was performed on the diverticulum and 20 cm in length of the transverse colon, followed by side-to-side anastomosis. Conclusion Differentiating GCD and GCF with similar clinical course may necessitate multiple investigation before establishing the correct diagnosis. We suggest colectomy followed by side-to-side anastomosis is the best option of treatment for GCD.

We present a case of a pregnant woman admitted for malnutrition secondary to a large gastrocolic fistula (GCF). She has a history of perforated duodenal ulcer that required surgical pyloroplasty 6 years ago. This fistula was diagnosed on the gastrointestinal barium series showing direct transit of barium from the stomach to the colon. An upper endoscopy showed a large gastrocolonic fistula with stool leaking to the stomach. Her nutrition was optimized, then she underwent surgical repair. GCF is suspected in the patient presenting with malnutrition with a history of intra-abdominal surgery.

Highlights • Leakage after sleeve gastrectomy is the cornerstone for most of its related morbidity and mortality. • Gastrocolic fistula is a rare complication resulting from chronic leak after laparoscopic sleeve gastrectomy. • A high index of suspicion is important in detection of rare complications including gastrocolic fistula. • Complete laparoscopic resection of gastrocolic fistula is preferred. • Gastrectomy might be the definitive surgery. • Re-do bariatric surgery should be only done by an expert bariatric surgeon with multidisciplinary team in a specialized center., Introduction Laparoscopic sleeve gastrectomy is a popular bariatric procedure. Leakage after sleeve gastrectomy is the cornerstone for most of its related morbidity and mortality. Gastrocolic fistula is a rare complication resulting from chronic leak after laparoscopic sleeve gastrectomy. Case presentation We report a case of 32-year-old male who underwent laparoscopic re-sleeve gastrectomy for weight regain after initial uneventful laparoscopic sleeve gastrectomy 3 years back. He presented to emergency department by septic shock secondary to leakage after sleeve gastrectomy. CT abdomen with IV contrast and oral gastrograffin confirmed post sleeve gastrectomy leak. Emergency diagnostic laparoscopy revealed a huge abscess cavity containing pus and dark fecal material and altered blood. A long leak was identified with eversion of gastric mucosa. Tubular structure connecting the upper part of the stomach and the colon was found which turned out to be a gastrocolic fistula. It was controlled by endoscopic linear stapler. After 6 weeks, a definitive open esophago-jeujonostomy with total gastrectomy was done successfully after difficult attempt of laparoscopic intervention. The patient was discharged home in a stable condition. Conclusion A high index of suspicion is important in detection of rare complications after laparoscopic sleeve gastrectomy including gastrocolic fistula. Complete laparoscopic resection of gastrocolic fistula is preferred. Gastrectomy might be the definitive surgery.

A 60-year-old male patient presented to the Emergency Room (ER) with a history of diarrhoea with abdominal pain for 2 weeks and weight loss of 3 kg over 1 month, the patient had a history of necrotising pancreatitis a month ago. On examination, patient was afebrile with tachycardia, tachypnoea

An adolescent patient developed vomiting 1 month after percutaneous endoscopic gastrostomy (PEG) insertion. A gastrostomy-tube contrast study confirmed the gastrocolic fistula. The gastrocolic fistula, a rare complication, should be considered in high-risk patients. After the first PEG tube insertion by Dr Gauderer in 1979,1 advances in the technique, use in adults and development of different types of tubes have helped various types of patients. Failure rates are similar between laparoscopic (0.5%) and PEG (0.9%) procedures; the later had a higher risk of complications of visceral injury and mechanical issues.2 Similar results were reported in a heterogeneous group of patients.3 However, PEG showed no differences in mortality or infection compared with percutaneous radiologic gastrostomy.4 Complications are inherent with any procedure; awareness of immediate and late complications of PEG insertion is vital. We discuss here a case pertinent to quiescent late (≥2 weeks) complication. An adolescent patient was neurologically devastated after a motor-vehicle-collision accident. The patient developed …

A 71-year-old lady presented with a 4-week-history of epigastric pain, feculent vomiting, diarrhoea and weight-loss. On subsequent investigations, she was found to have a complex gastro-cholecysto-colic fistula with no clear underlying aetiology. The only abnormality both macroscopically and microscopically was ulceration and inflammation in the colon. However, this was not pathognomonic of inflammatory bowel disease, and (gastric) acid-induced inflammation is an alternative explanation. Herein we present her case, her comprehensive evaluation, her successful surgical management and a review of the relevant literature.

Gastrocolic fistula (GSF) is a rare entity that arises mainly from splenic or gastric lymphoma. Gastric and splenic lymphomas can also fistulate with other organs, including the pleura and the colon, but there has been no reported case to best of our knowledge of a fistula involving three different organs. We hereby present the case of a female patient with gastrosplenocolic fistula secondary to non-Hodgkin B-cell lymphoma. We performed an en bloc partial gastrectomy with splenectomy and partial left colon resection with colostomy. GSF can be treated with chemotherapy. However, when the definite diagnosis is unclear or GSF is causing serious complications such as bleeding or active infection, we believe surgical excision is the treatment of choice.

Over-the-counter analgesic medications are widely used amongst American adults and are also available in powder forms. Their adverse effects have been well documented in literature. Gastrocolic fistulas as a complication of peptic ulcer disease from analgesic powder usage have been previously unreported. Here, we report a patient with upper gastrointestinal bleeding and acute anaemia secondary to peptic ulcer complicated by gastrocolic fistula in a patient using analgesic powder.

Currently, surgery is less needed for the treatment of refractory peptic ulcer disease (PUD) or its complications. So, the complications of PUD surgery have been clearly declined. Here in, we present a 42-year-old man with chronic watery diarrhea and significant weight loss during 2 years after gastrojejunostomy for the treatment of obstructive PUD. Small bowel gastrointestinal series showed rapid transit without passage of contrast in the parts of small bowel. The patient was scheduled for exploratory laparotomy. During the surgery a large fistula was detected between the stomach and transverse colon, which was repaired. At the follow-up 6 months after the surgery, the patient did not have any history of recurrence of diarrhea and had 10 kg weight gain. Gastrocolic fistula is a very rare complication of surgical management of PUD. Barium enema is the most helpful imaging procedure for the diagnosis of gastrocolic fistula and surgery after correction of nutritional status is suggested especially for malnourished patients.

Management of the leak is determined by the duration of the leak from the initial surgery. Acute leaks occurring less than 72 hours after surgery are best managed with reoperation and primary repair. Intermediate leaks, greater than 72 hours but less than 12 weeks, can be managed with non-operative management in non-septic patients. When non-operative management fails beyond 12 weeks the leak is considered a chronic fistula which are best treated with definitive operative management. Sub-total gastrectomy with Roux-En-Y reconstruction with gastrojejunostomy, has been reported with resolution of the fistula in over 90% of cases. To demonstrate the operative management of chronic sleeve gastrectomy leaks. A 37-year-old male with a history of a sleeve gastrectomy, developed a chronic fistula between the distal gastric staple line and the transverse colon. After non-operative management failed the patient was taken to the operating room for a diagnostic laparoscopy with plans to perform a revision. A fistula between the distal sleeve staple line and the transverse colon was identified. The gastroesophageal junction was dissected and inspected, there was no fistula at the angle of His. A near total gastrectomy was then performed leaving a small gastric pouch. The colonic side of the fistula was oversewn. Roux-En-Y reconstruction was then performed. No leak identified at four-month follow-up. Leak after sleeve gastrectomy can be difficult to manage. Chronic leaks do not respond well to non-operative management. Partial gastrectomy with Roux-En-Y reconstruction is a technically challenging option with good results.

Colonic self‑expanding metal stent (SEMS), although associated with high technical and functional success in malignant colonic obstruction, may be associated with complications such as migration. Furthermore, fistulous tract formation with SEMS in situ has been reported only in few case reports previously. Here, we present a case of colonic SEMS migrating through a gastrocolic fistula into the stomach. There are no previous reports of migration of a colonic SEMS into a proximal segment of the gastrointestinal tract.

Aim. Improving the diagnosis and treatment of multiple complications of peptic ulcer. Materials and Methods. Retrospective analysis of clinical signs, results of laboratory, instrumental examinations and surgical treatment of multiple peptic ulcer complications in a 54-year-old patient H., who was treated at the Department of Surgery №2 of Lviv Regional Clinical Hospital. Results and Discussion. In a 54-year-old patient with 20 years history of peptic ulcer, a combined complication developed: decompensated pyloric stenosis, penetration of gastric ulcers to the transverse colon with formation of a gastro-colic fistula, which was confirmed only at contrast CT of abdominal cavity. These complications led to severe disturbance of fluid-electrolyte and acid-base balance. After the correction of fluid-electrolyte and acid-base balance, a one-stage operation was performed - the Billroth II resection of the stomach with gastro-enterostomy on a short loop, and transverse colon resection with end-to-end anastomosis. Conclusions. Verification of diagnosis in patients with peptic ulcers with multiple complications needs advanced diagnostic procedures. Combination of gastric outlet obstruction and penetration of peptic ulcer to the transverse colon with fistula formation lead to significant disturbances of water-electrolyte and acid-base balance. Simultaneous operation (Billroth II gastric resection and resection of the transverse colon with end-to-end anastomosis) is possible after thorough correction of fluid-electrolyte and acid-base balance.

Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula.In total, seven high-risk individuals diagnosed using computed tomography (CT)-gastrocolonography (GC) underwent laparoscopic-assisted PEG (LAPEG) placement. Study endpoints included the success of LAPEG under local anesthetic and intravenous sedation, inability to thread the PEG tube, the eventual tube location, the number of tube adjustments needed, adverse events, the operating time, and PEG tube-related infection.In total, 135 PEG procedures were performed during this study. Successful CT-GC was achieved in all 135 patients, and we successfully used a standard PEG technique to place the gastrostomy tube in 128 patients (95%). In seven patients (5%), the LAPEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. LAPEG procedure-related minor complications were observed in two patients.LAPEG combined with CT-GC can be used for patients with difficult anatomical orientations and may minimize the risk of complications in PEG placement.

Background Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. Methods In total, 48 individuals underwent computed tomography-gastro-colonography (CT-GC)-guided PEG placement. Study end points included success of CT-GC, inability to thread the PEG tube, the eventual tube location, tube adjustments needed, adverse events, operating time, and PEG tube-related infection. Results A successful CT-GC was achieved in all 48 patients (100%), and we successfully used a standard PEG technique to place the gastrostomy tube in 44 patients (92%). In 4 patients (8%), the laparoscopic-assisted PEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. The overall procedure-related minor complication rate was 8%. Conclusion CT-GC is an optional method for the estimation of intra-abdominal, anatomical orientations that may minimize the risk of complications before PEG placement.

Highlights • The common cause of gastrocolic fistula is different between eastern and western countries. • The best diagnosing methods of gastrocolic fistula are barium enema and digestive endoscopy. • The therapy for gastrocolic fistula remains surgery., Introduction Gastrocolic fistula secondary to colon carcinoma is a rare entity. The common cause of gastrocolic fistula is different between eastern and western countries. Gastrocolic fistula may present many manifestations. Presentation of case We present a case report of gastrocolic fistula in a 59-year-old male patient with colon adenocarcinoma, diagnosed on digestive endoscopy, CT scanning and barium enema. Radical en-bloc surgery was undertaken based on patient’s symptom, the size and the nature of the tumor. Discussion The typical symptoms of gastrocolic fistula include abdominal pain, vomiting, diarrhea, emaciation, anemia, hypoaluminemia, weight loss and ascites. There are many methods to diagnose gastrocolic fistula, but barium enema is the most accepted way nowadays. Conclusion It is rare for gastrocolic fistula case to be caused by colon adenocarcinoma, and has been rarely reported inside China. The best therapy of gastrocolic fistula remains radical en-bloc surgery.

Percutaneous placement of gastrostomy was first described in 1980. Since then it has become widely used in pediatric surgery throughout the world. Inherent in the technique is the possibility of inadvertent damage to adjacent anatomical structures, most commonly the transverse colon. Management previously had involved laparotomy and correction of the gastrocolic fistula. Here we describe a novel laparoscopic approach to the repair of a gastrocolic fistula following percutaneous gastrostomy, avoiding the morbidity of laparotomy in an immunocompromised patient with a rotund abdomen secondary to steroid usage.

Nowadays the development of a gastro-colic fistula is usually due to malignant disease in the gastro-intestinal tract. The symptoms can vary extensively and establishing the diagnosis quite challenging. We describe the case of a gastro-colic fistula with a complicated course and review the literature.

症例は68歳，男性．不消化性の下痢，曖気の精査加療目的で入院となった．腹部CTで下行結腸～脾彎曲にかけて13cm大の腫瘤性病変を認めた．下部消化管内視鏡検査では下行結腸に隆起を主体とする5型病変を認め，ファイバーは潰瘍底より容易に胃内へと挿入された．腫瘍からの生検で高分化型腺癌と診断された．胃結腸瘻を形成した進行下行結腸癌と診断し，左半結腸切除術，D3リンパ節郭清，胃全摘，膵尾部・脾臓合併切除術を施行した．最終診断はmuc，si，n0，ly0，v0，ow(－)，aw(－)，stageIIで，手術根治度Aであった．われわれは内視鏡が通過することで診断できた胃結腸瘻を形成した下行結腸癌の1例を経験したので，自験例を加えた本邦報告25例の集計および文献的考察を行った．

Highlights • The symptoms of gastrocolic fistulae are often undifferentiated. • Barium enemas are the most accurate for diagnosis but gastroscopy should be performed to rule out malignancy. • The mainstay of treatment of gastrocolic fistulae is surgical., INTRODUCTION In the era of proton pump inhibitors in the treatment of peptic ulcer disease, the incidence of a gastrocolic fistula arising from unoperated gastric ulcers is extremely low. PRESENTATION OF CASE We present the case of a 68-year old farmer who presented with melaena and was found to have a benign gastrocolic fistula in the setting of untreated peptic ulcer disease, chronic NSAID ingestion and heavy alcohol intake. The diagnosis was made by gastroscopy. En bloc surgery was undertaken due to the size of the fistula and concomitant significant bleeding of the ulcer which would not have made it amenable to medical management. DISCUSSION The symptoms of a gastrocolic fistula are undifferentiated and the diagnosis can easily be missed in the setting of other complications such as bleeding or perforation of a hollow viscus. Barium enamas are the most accurate for the diagnosis but gastroscopy with biopsy is usually performed to rule out malignancy. The mainstay of treatment is usually surgical, though patients can be medically managed if he/she is not a surgical candidate. CONCLUSION Benign gastrocolic fistulas are rare and its diagnosis is easily missed.

Gastrocolic fistula is a rare complication which is seen after percutaneous endoscopic gastrostomy (PEG). It usually manifest as a late complication. Interesting fact is that gastrocolic fistula is formed during the initial insertion of PEG tube itself but goes unrecognized. It becomes evident only when a tube replacement is done or when tube dislodgement occurs. We report a case where gastrocolic fistula was recognized after 1 month of tube feeding. Aim of our case report is to make clinicians aware of this rare condition and to have high clinical suspicion regarding possible complications of PEG even after a long period of uncomplicated feeding.

We herein report the case of a 51-year-old man with gastrojejunocolic fistula. It is one of the late severe complications of gastrectomy and gastrojejunostomy and is considered to be induced by a stomal ulcer due to inadequate resection of the stomach and incompleteness of vagotomy. The main clinical presentation of this condition is chronic abdominal pain, weight loss, diarrhea, gastrointestinal bleeding and fecal vomiting. The diagnostic workup should include barium enema, gastroscopy and sometimes colonoscopy and abdominal tomography for excluding and ruling out the possibility of malignant extraluminal disease. The historical approach of the treatment of this rare entity was 2–3-phased operations which included colostomy. However today, medical management has recently been recommended as the first-line therapy, with parenteral and enteral support treatments. The preferred surgical approach is single-stage gastrocolic resection and anastomosis and this has been favored to minimize mortality.

胃結腸瘻は悪性腫瘍や胃空腸吻合術後の合併症として報告されることは多いが, 良性胃潰瘍を原因とする報告は少ない. 今回, 我々はその1例を経験したので報告する. 症例は48歳の男性で, 腹痛および嘔吐を主訴に入院した. 既往歴では胃潰瘍を指摘されていたが無治療であった. 上部消化管造影X線検査では胃後壁から造影剤が漏出し, 結腸が造影された. 上部消化管内視鏡検査では胃体下部後壁に瘻孔を認め, 結腸への内視鏡の挿入が可能であった. 注腸造影X線検査では横行結腸から造影剤が漏出し, 胃が造影された. 以上より, 胃潰瘍が横行結腸に穿通し瘻孔を形成したものと診断し, 開腹手術を施行した. 横行結腸は胃後壁に入り込み癒着し, 瘻孔を形成していた. 広範囲胃切除, 横行結腸部分切除術を施行した. 切除標本では後壁に潰瘍を認めた. 病理組織診断により胃潰瘍による胃結腸瘻と診断され, 悪性所見は認めなかった.

出血性胃潰瘍にて発見された胃横行結腸瘻について1症例を経験したため報告する. 症例は60歳,男性.突然黒赤色の吐物を嘔吐し,当院受診した.以前より胃潰瘍を指摘されており,数カ月前より,激しい下痢が飲酒をすると生じていたが放置していた.血液検査にて血色素量5.8g/dlと高度貧血を認めたため,緊急胃内視鏡検査を施行した.小彎側に潰瘍をみとめ,辺縁の潰瘍からの出血の可能性を考え,全身状態管理,貧血改善目的入院となった.瘻孔が疑われ施行した胃透視造影にて,胃角部小彎後壁よりに横行結腸との間に瘻孔形成がみられ,注腸CTにて横行結腸より胃に流入する造影剤を確認した.全身状態の改善後,外科にて,潰瘍切除と瘻孔閉鎖を目的に手術を施行した. 手術は選択的迷走神経切離を付加した胃部分切除,横行結腸部分切除を施行した.術後病理検査にて悪性所見は認められなかった. 胃結腸瘻の原因は胃癌や結腸癌など悪性腫瘍によるものが多く,良性疾患によるものとして最も多いのは胃切除後の吻合部潰瘍である.本症例は胃非切除例の出血性胃潰瘍によるものであり,瘻孔の稀な一原因として考慮が必要と考えた.

症例は84歳,男性.体重減少および下痢を主訴に来院した.入院時検査において貧血・栄養不良を認めた.上部消化管内視鏡検査にて胃体中部大彎側に2型の腫瘤を認め,生検にて低分化型腺癌あるいは扁平上皮癌と診断を得た.注腸では横行結腸と胃体中部大彎側に瘻孔を認めた.横行結腸に穿通した胃癌と診断し,幽門側胃切除術・横行結腸部分切除術および2群のリンパ節郭清を施行した.術後の病理検査では,標本を全割し検索したが,腺癌成分は認めず,扁平上皮癌と診断した. 胃扁平上皮癌は稀な癌であり,その頻度は約0.09%といわれている.われわれの検索した限り,本邦では26例の報告を認めるのみである.また,胃結腸瘻も比較的珍しく,胃扁平上皮癌との合併は今までに報告されておらず極めて稀な症例と思われ,若干の考察を加え報告する.

Gastrocolic fistulas in children are most commonly seen after placement of a percutaneous endoscopic gastrostomy. We present a 14-year-old girl who developed a gastrocolic fistula following accidental corrosive acid ingestion. On evaluation of her symptoms, a barium swallow identified the gastrocolic fistula. It healed spontaneously in 3 months. This was both unexpected and remarkable. To the best of our knowledge this is the first case of a gastrocolic fistula occurring following corrosive ingestion.