Cargando…
Palliative end ileostomy and gastrojejunostomy for a metastatic distal transverse colonic malignancy complicated by a proximal duodenocolic fistula: a case report
BACKGROUND: Fistulae between the colon and upper gastrointestinal tract are distressing and uncommon complications of malignancies involving this region. We report a case of a middle-aged man with a locally advanced and metastatic distal transverse colon malignancy who presented with a duodenocolic...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5554982/ https://www.ncbi.nlm.nih.gov/pubmed/28803550 http://dx.doi.org/10.1186/s13256-017-1398-9 |
_version_ | 1783256864808501248 |
---|---|
author | Pamathy, Gnanaselvam Jayarajah, Umesh Gunathilaka, Yapa Hamillage Hemantha Sivaganesh, Sivasuriya |
author_facet | Pamathy, Gnanaselvam Jayarajah, Umesh Gunathilaka, Yapa Hamillage Hemantha Sivaganesh, Sivasuriya |
author_sort | Pamathy, Gnanaselvam |
collection | PubMed |
description | BACKGROUND: Fistulae between the colon and upper gastrointestinal tract are distressing and uncommon complications of malignancies involving this region. We report a case of a middle-aged man with a locally advanced and metastatic distal transverse colon malignancy who presented with a duodenocolic fistula proximal to the primary tumor and underwent palliative surgery. CASE PRESENTATION: A 50-year-old Sri Lankan man presented to our hospital with a history of feculent vomiting of 1 week’s duration preceded by worsening constipation and abdominal fullness of 2 months’ duration. He also complained of anorexia and significant weight loss over the previous month. His physical examination was unremarkable except for his wasted appearance. Flexible sigmoidoscopy done at his local hospital had not revealed any abnormality in the left colon. Gastroduodenoscopy did not reveal fecal matter or any mucosal abnormalities in the stomach or duodenum. An abdominal contrast-enhanced computed tomographic scan showed a mid-to-distal transverse colonic tumor with a duodenocolic fistula proximal to the primary lesion. At laparotomy, he was found to have an unresectable, locally advanced mid transverse colon tumor with diffuse peritoneal and mesenteric deposits and mild ascites. Palliative end ileostomy and gastrojejunostomy were performed before closure. Histology from the malignant deposits revealed a well-differentiated adenocarcinoma. He made an uneventful recovery with good symptomatic relief. CONCLUSIONS: Malignant gastric or duodenocolic fistulae are uncommon complications of locally advanced colonic malignancies with direct invasion to the stomach or duodenum. Although the characteristic clinical presentation of feculent vomiting suggests the diagnosis, cross-sectional imaging is confirmative in addition to staging the disease. Management is guided by disease stage, nutritional status, and the general condition of the patient and ranges from extensive bowel resection including the fistula to palliative options. |
format | Online Article Text |
id | pubmed-5554982 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-55549822017-08-16 Palliative end ileostomy and gastrojejunostomy for a metastatic distal transverse colonic malignancy complicated by a proximal duodenocolic fistula: a case report Pamathy, Gnanaselvam Jayarajah, Umesh Gunathilaka, Yapa Hamillage Hemantha Sivaganesh, Sivasuriya J Med Case Rep Case Report BACKGROUND: Fistulae between the colon and upper gastrointestinal tract are distressing and uncommon complications of malignancies involving this region. We report a case of a middle-aged man with a locally advanced and metastatic distal transverse colon malignancy who presented with a duodenocolic fistula proximal to the primary tumor and underwent palliative surgery. CASE PRESENTATION: A 50-year-old Sri Lankan man presented to our hospital with a history of feculent vomiting of 1 week’s duration preceded by worsening constipation and abdominal fullness of 2 months’ duration. He also complained of anorexia and significant weight loss over the previous month. His physical examination was unremarkable except for his wasted appearance. Flexible sigmoidoscopy done at his local hospital had not revealed any abnormality in the left colon. Gastroduodenoscopy did not reveal fecal matter or any mucosal abnormalities in the stomach or duodenum. An abdominal contrast-enhanced computed tomographic scan showed a mid-to-distal transverse colonic tumor with a duodenocolic fistula proximal to the primary lesion. At laparotomy, he was found to have an unresectable, locally advanced mid transverse colon tumor with diffuse peritoneal and mesenteric deposits and mild ascites. Palliative end ileostomy and gastrojejunostomy were performed before closure. Histology from the malignant deposits revealed a well-differentiated adenocarcinoma. He made an uneventful recovery with good symptomatic relief. CONCLUSIONS: Malignant gastric or duodenocolic fistulae are uncommon complications of locally advanced colonic malignancies with direct invasion to the stomach or duodenum. Although the characteristic clinical presentation of feculent vomiting suggests the diagnosis, cross-sectional imaging is confirmative in addition to staging the disease. Management is guided by disease stage, nutritional status, and the general condition of the patient and ranges from extensive bowel resection including the fistula to palliative options. BioMed Central 2017-08-14 /pmc/articles/PMC5554982/ /pubmed/28803550 http://dx.doi.org/10.1186/s13256-017-1398-9 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Report Pamathy, Gnanaselvam Jayarajah, Umesh Gunathilaka, Yapa Hamillage Hemantha Sivaganesh, Sivasuriya Palliative end ileostomy and gastrojejunostomy for a metastatic distal transverse colonic malignancy complicated by a proximal duodenocolic fistula: a case report |
title | Palliative end ileostomy and gastrojejunostomy for a metastatic distal transverse colonic malignancy complicated by a proximal duodenocolic fistula: a case report |
title_full | Palliative end ileostomy and gastrojejunostomy for a metastatic distal transverse colonic malignancy complicated by a proximal duodenocolic fistula: a case report |
title_fullStr | Palliative end ileostomy and gastrojejunostomy for a metastatic distal transverse colonic malignancy complicated by a proximal duodenocolic fistula: a case report |
title_full_unstemmed | Palliative end ileostomy and gastrojejunostomy for a metastatic distal transverse colonic malignancy complicated by a proximal duodenocolic fistula: a case report |
title_short | Palliative end ileostomy and gastrojejunostomy for a metastatic distal transverse colonic malignancy complicated by a proximal duodenocolic fistula: a case report |
title_sort | palliative end ileostomy and gastrojejunostomy for a metastatic distal transverse colonic malignancy complicated by a proximal duodenocolic fistula: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5554982/ https://www.ncbi.nlm.nih.gov/pubmed/28803550 http://dx.doi.org/10.1186/s13256-017-1398-9 |
work_keys_str_mv | AT pamathygnanaselvam palliativeendileostomyandgastrojejunostomyforametastaticdistaltransversecolonicmalignancycomplicatedbyaproximalduodenocolicfistulaacasereport AT jayarajahumesh palliativeendileostomyandgastrojejunostomyforametastaticdistaltransversecolonicmalignancycomplicatedbyaproximalduodenocolicfistulaacasereport AT gunathilakayapahamillagehemantha palliativeendileostomyandgastrojejunostomyforametastaticdistaltransversecolonicmalignancycomplicatedbyaproximalduodenocolicfistulaacasereport AT sivaganeshsivasuriya palliativeendileostomyandgastrojejunostomyforametastaticdistaltransversecolonicmalignancycomplicatedbyaproximalduodenocolicfistulaacasereport |