An Unusual Cause of Gastrointestinal Hemorrhage: Gastrocolic Fistula Caused by Colon Cancer Invasion

Cho, Jeong Hyeon; Kim, In Tae; Choi, Jin Yi; Chun, Song Wook; Kang, Beo Deul; Bae, Sang Kyun; Kim, Hee Man; Song, Ji Sun

doi:10.12701/yujm.2013.30.1.43

Case Report


Yeungnam Univ J Med. 2013 Jun;30(1):43-46. Korean. Published online June 30, 2013. https://doi.org/10.12701/yujm.2013.30.1.43
Copyright © 2013 Yeungnam University College of Medicine


An Unusual Cause of Gastrointestinal Hemorrhage: Gastrocolic Fistula Caused by Colon Cancer Invasion
Jeong Hyeon Cho, In Tae Kim, Jin Yi Choi, Song Wook Chun, Beo Deul Kang, Sang Kyun Bae, Hee Man Kim, and Ji Sun Song¹
Department of Internal Medicine, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.
¹Department of Pathology, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.
Corresponding Author: Hee-Man Kim, Division of Gastroenterology, Department of Internal Medicine, Myoung Ji Hospital, Kwan Dong University College of Medicine, 55 Hwasu-ro 14 beon-gil, Deogyang-gu, Goyang 412-826, Korea. Tel: 82-31-810-5412, Fax: 82-31-969-0500, Email: eastin@kd.ac.kr

Received January 16, 2013; Revised February 22, 2013; Accepted March 04, 2013.

Go to: Abstract
Gastrocolic fistula is a fistulous communication between the stomach and the colon. It is a passage between the gastric epithelium and the colonic epithelium. This uncommon complication is caused by benign and malignant diseases of the stomach or the colon. Its clinical manifestations include weight loss, diarrhea and fecal vomiting; occasionally, anemia, poor oral intake, fatigue and dizziness; and very rarely, gastrointestinal bleeding. In this paper, an unusual case of gastrocolic fistula accompanied by hematochezia, which was revealed to have been caused by colon cancer invasion, is described.


Keywords: Intestinal fistula; Hematochezia; Colon cancer

Go to:

Figures


	Fig. 1 Endoscopic findings. (A) Basal defect of gastric ulcer with bleeding. (B) Colonic mucosa was seen when endoscope goes through the defect area.
	Click for larger image


	Fig. 2 Computed tomographic findings. (A, B) Hepatic flexure of colon cancer (arrow) shows direct invasion to the gastric antrum with gastrocolic fistula formation (arrow head).
	Click for larger image


	Fig. 3 Gross findings of the colon. (A) The segmental resected colonic mucosa shows a perforated ulcero-infiltrative tumor, resulting in the formation of the gastrocolic fistulous opening of the gastrocolic fistula. (B) On section, the gray-white colonic tumor infiltrates to the adhesive pericolic fat tissue along the fistulous tract.
	Click for larger image


	Fig. 4 Microscopic findings. (A, B) Colon. The ulceroinfiltrative tumor consists of irregular gland-forming adenocarcinoma arising from colonic mucosa and infiltrating toward muscularis propria (arrow) (H&E stain, ×40, ×200). (C, D) Stomach. The adenocarcinomatous glands show transmural invasion through gastric wall along the fistulous tract (arrow) (H&E stain, ×20, ×200).
	Click for larger image

Go to:

Tables


	Table 1 Analysis of gastrocolic fistula cases in Korea
	Click for larger image

Go to:

References


1.	Yoon HY, Kim BC, Sohn TK, Cho JW, Chung BW, Chung KS, et al. A case of gastrocolic fistula by primary colon cancer. J Korean Soc Coloproctol 2004;20:415–419. Korean.

2.	Choi YH, Kweon YO, Kim SK, Cheigh YH, Yu WS, Choi SG, et al. A caae of gastrocolie fistula secondary to benign gastric ulcer. Korean J Gastrointest Endosc 1996;16:615–619. Korean.

3.	Lee LS, Foo CS, Chen CM, Poh CC. Gastrocolic fistula: a rare complication of gastric carcinoma. Singapore Med J 2009;50:e274–e276.

4.	Aydin U, Yazici P, Ozütemiz O, Güler A. Outcomes in the management of gastrocolic fistulas: a single surgical unit's experience. Turk J Gastroenterol 2008;19:152–157.

5.	Singh V, Wadleigh R. Gastrocolic fistula as a complication of colon carcinoma--a case report. Acta Oncol 1997;36:817–818.

6.	Nam JH, Kim JH, Park JE, Kim HJ, Lee SH, Ahn BK, et al. A case of gastrojejunocolic fistula as a complication after gastrojejunostomy. Korean J Gastrointest Endosc 2005;31:116–120. Korean.

7.	Marshall SF, Knud-Hansen J. Gastrojejunocolic and gastrocolic fistulas. Ann Surg 1957;145:770–782.

8.	Yang SY, Byun TJ, Yun YS, Park JI, Sohn JH, Lee DH. A case of gastrocolic fistula as a complication of colon cancer. Korean J Gastroenterol 2003;41:406–409. Korean.

9.	Chung JM, Choi YH, Kweon YO, Kim SK, Choi SG, Cheigh YH, et al. A case of gastrocolic fistula secondary to colon cancer. Korean J Gastrointest Endosc 1995;15:755–763. Korean.

*10.*	Rots WI, Mokoena T. Successful endoscopic closure of a benign gastrocolonic fistula using human fibrin sealant through gastroscopic approach: a case report and review of the literature. Eur J Gastroenterol Hepatol 2003;15:1351–1356.

*11.*	Forshaw MJ, Dastur JK, Murali K, Parker MC. Long-term survival from gastrocolic fistula secondary to adenocarcinoma of the transverse colon. World J Surg Oncol 2005;3:9.

*12.*	Choi SW, Yang JM, Kim SS, Kang SH, Ro HJ, Song KS, et al. A case of combined gastrojejunal and gastrocolic fistula secondary to gastric cancer. J Korean Med Sci 1996;11:437–439.

*13.*	Lee JY, Jang KM, Yoon HS, Kim MJ, Lee K, Lee Y, et al. Gastro-umbilical fistula as a rare complication of benign gastric ulcer perforation: a case report. J Korean Radiol Soc 2007;57:455–457.

*14.*	Rho JC. Gastrocolic fistula secondary to carcinoma of the stomach. J Korean Surg Soc 1967;9:771–775. Korean.

*15.*	Oh IS, Kim JH, Min JS, Whang KC, Park IS. Gastrocolic and gastrojejunocolic fistulas caused by gastric ulcer. Korean J Gastroenterol 1977;9:129–134. Korean.