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Abstract
Colocolic fistulas are usually a complication of an inflammatory or neoplastic process. Development of these abnormal bowel communications may lead to bacterial overgrowth. We report on a 71-year-old man with a one-year history of recurrent abdominal distension and irregular bowel habits. Abdominal X-rays and computed tomography showed multiple air-fluid levels and loops of distended bowel without evidence of mechanical obstruction or diverticulitis. Colonoscopy showed a fistulous tract between the sigmoid colon and cecum. Results of a lactulose breath test showed high fasting breath CH4 levels, which were thought to be the result of intestinal bacterial overgrowth. The patient was diagnosed with a colonic pseudoobstruction associated with bacterial overgrowth due to a sigmoidocecal fistula. We recommended surgical correction of the sigmoidocecal fistula; however, the patient requested medical treatment. After antibiotic therapy, the patient still had mild symptoms but no acute exacerbations.
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Fig. 1.
Plain abdominal radiography in erect position. Distended intestine, especially the large intestine, and multiple air-fluid levels are seen.
Fig. 2.
Colonoscopic findings. White numbers corresponding to the insertion lengths of the colonoscope could be seen through the fistulous opening located in the cecum. The appendiceal orifice was normal.
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