Benign duodenocolic fistula; review of the literature and case report.

Abstract

The discovery and management of a benign duodenocolic fistula presented certain features which we believe warrant reporting and emphasizing. This case is summarized along with all other previously reported cases that we were able to find in the literature. R. S., a 48-year-old unemployed white man, was admitted to Parkland Hospital on Sept. 24, 1951, complaining of lower abdominal pain, chills and fever, diarrhea with dark watery stools eight to twelve times a day, a weight loss of approximately 30 pounds, and progressive weakness. Five weeks before admission, he experienced the onset of epigastric pain which after a few hours became generalized but was worse in the right lower quadrant. He described himself as being acutely ill for the next five days with a temperature as high as 102° F., chills on three alternate days, abdominal distention, and vomiting. As treatment during this period he received only aspirin, local heat to the right lower quadrant of the abdomen, and bed rest. Following the first six days of his illness he began to improve gradually, but diarrhea appeared and persisted until admission, as did the weakness and weight loss. Ten days prior to admission he noticed the onset of night sweats. Six days prior to admission, he had a sudden recurrence of pain, which was relieved by aspirin and a hot water bottle. Following the initial acute period, he noticed that his stools had become darker than previously and he thought at times they were black. The past history revealed that on Oct. 16, 1950, he had undergone cholecystectomy in another hospital, with an uneventful postoperative course. Between the ages of twenty and thirty he had taken excessively large amounts of alcohol, and in 1924 he was advised to enter a tuberculosis sanitarium, which he did not do. The patient appeared undernourished and chronically ill, with evidence of recent weight loss. Blood pressure was 110/68, pulse 98, respirations 28, temperature 99.2° F., weight 118 pounds. Physical examination was not remarkable except for mild abdominal tenderness, slightly greater to the right of the umbilicus in the mid-clavicular line. There was a small hernia through a right upper abdominal transverse incision. Laboratory Findings: Hemoglobin 11.5 gm., red blood count 3.7 million, white blood count 11,233, with a shift to the left. Urinalysis was negative except for 4 plus acetone. CO2 plasma was 23.1 milliequivalents per liter, Cl 91.8 milliequivalents per liter. Cephalin cholesterol flocculation test was 3 plus in twenty-four hours, and the feces were strongly positive for occult blood on one occasion. The remainder of the laboratory findings were within normal limits. Roentgen Findings: Because diverticulitis of the colon was suspected clinically, a barium enema study was undertaken. The barium flowed easily to the ascending colon, then suddenly appeared outside the colon, above and below the transverse segment.