Idiopathic Fistula Formation in the Gastrointestinal Tract

Abstract

Summary A patient is reported with severe malabsorption and inanition due to multiple fistulous tracts between the small bowel and colon and between adjacent loops of small bowel. Jejunal diverticulosis and idiopathic obliteration of the peritoneal cavity by old adhesions were also present. Only two other similar cases have been found in a review of the literature. The etiology of the fistulous tracts in these patients is unknown. However, in view of the dense adhesions and marked obliteration of the peritoneal cavity it is possible that the fistulas developed between the closely bound loops of bowel, possibly through inflamed diverticula. This unusual malabsorption syndrome should be suspected in patients presenting with the following findings: 1) rapid intestinal transit of food or barium in the absence of a past history of intra-abdominal disease; 2) normal small bowel mucosal pattern by x-ray and essentially normal biopsy; and 3) small intestinal diverticulosis. Although the fistulous tracts may fail to visualize on radiological examination of the upper GI tract, they should be readily demonstrable by barium enema.