Abstract
Introduction: Gastrojejunocolic fistula (GJCF) is a rare, preventable and debilitating complication of surgery for peptic ulcer. It commonly follows posterior gastrojejunostomy without/with incomplete vagotomy for peptic ulcer disease. Over period of time, with advances in medical science the modalities used in diagnosis and the treatment have changed. GJCF is associated with high morbidity and mortality. The objective of this study was to analyze our experience in the management of GJCF. Materials and methods: Between 1993 and 2017, 13 patients presented with GJCF after surgery for peptic ulcer disease at our hospital for elective surgery. Data from the records of these patients was analyzed retrospectively. Weight loss, faeculant vomiting and diarrhoea were the common symptoms. Diagnosis of GJCF was made by barium enema, upper gastrointestinal endoscopy, colonoscopy and CT scan abdomen. All patients underwent surgery- single stage 9 patients, two stages 2 patients and closure of fistula with distal gastrectomy in 2 patients. Conclusion: GJCF should be considered as a diagnosis in patients presenting with one or more of the clinical symptoms- faeculent vomiting, chronic diarrhoea, weight loss after surgery for peptic ulcer. Diagnosis of GJCF has evolved for barium enema to colonoscopy and CT scan. Depending on the nutritional status of patient the trend in the surgery has changed from multiple stages to single stage surgery.
Highlights
Gastrojejunocolic fistula (GJCF) is a rare, preventable and debilitating complication of surgery for peptic ulcer
Faeculant vomiting was present in 10/13 patient (76.9%), diarrhoea in 9/13(69.2%) and weight loss was present in all patients (100%)
GJCF should be considered as a diagnosis in patient presenting with one or more of the clinical symptoms after a period following surgery for peptic ulcer disease
Summary
Gastrojejunocolic fistula (GJCF) is a rare, preventable and debilitating complication of surgery for peptic ulcer. It commonly follows posterior gastrojejunostomy without/with incomplete vagotomy for peptic ulcer disease. Diagnosis of GJCF was made by barium enema, upper gastrointestinal endoscopy, colonoscopy and CT scan abdomen. Conclusion: GJCF should be considered as a diagnosis in patients presenting with one or more of the clinical symptoms- faeculent vomiting, chronic diarrhoea, weight loss after surgery for peptic ulcer. Diagnosis of GJCF has evolved for barium enema to colonoscopy and CT scan. Gastrojejunocolic fistula (GJCF) is a rare and late complication of peptic ulcer surgery. Diagnostic modalities have changed over time from barium enema to Endoscopy/ colonoscopy to CT scan abdomen. Trends in treatment have changed due to advances in pre-operative nutrition support, antibiotics and post-operative critical care support from three stage procedure to single stage procedure which can even be performed laparoscopically
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