Duodenocolic fistula due to carcinoma of the hepatic flexure; report of a case with a discussion of the surgical problems encountered.

Abstract

The occurrence of a fistula between the duodenum and the proximal transverse colon is relatively rare, although these two structures commonly lie in intimate relationship to each other. It is not uncommon for tumors of the right colon and proximal transverse colon to involve the duodenum by contiguity, but the bowel symptoms usually lead to diagnosis and operation before a carcinomatous fistula develops between the colon and the duodenum. We have never seen a duodenocolic fistula caused by peptic ulcer disease. The addition of a duodenocolic fistula to the problem of treatment of carcinoma of the colon is indeed a major handicap. The fistula adds profound disturbances in electrolyte, fluid, and protein (nutritional) balance which are difficult, if not impossible, to correct as long as the fistula exists. To operate without their correction is to court almost certain disaster. These problems and a method of their solution are presented because