Spontaneous gastrocutaneous fistula

Abstract

Gastrocutaneous fistula is an infrequent but a serious surgical complication confronting the surgeon. Isolated and spontaneous gastrocutaneous fistula is an entity which has received scant attention in the surgical literature. Herein, we report a 68-year-old patient who came to the surgical outpatient with a history of recurrent abdominal pain for 1 year and discharge from just above the umbilicus for 3 days. He had no past history of abdominal surgeries. There were no comorbid conditions afflicting him. On examination, there was a stoma above the umbilicus with surrounding hyperemia of the skin. Bile-tinged fluid noted discharging from the external opening. Abdominal contrast-enhanced computed tomography (CECT) showed a fistulous tract from the skin surface to the anterior surface of the stomach with extravasation of contrast into rectovesical pouch. Upper gastrointestinal endoscopy showed Grade 3 esophageal candidiasis. Clinical diagnosis of gastrocutaneous fistula was made. Laparotomy revealed a gastrocutaneous fistula from the anterior wall of the stomach to the anterior abdominal wall. The fistula was excised and the gastric defect closed. Edges of the gastric perforation were biopsied and a feeding jejunostomy was placed. The patient succumbed to acute respiratory distress syndrome (ARDS) in the postoperative period. Histopathological examination revealed normal gastric mucosal lining with fibrosis and chronic inflammation in the submucosa with no evidence of malignancy. The most likely cause for such a fistula appears to be a benign gastric ulcer causing chronic inflammation and erosion, which is a rare entity and must be borne in mind in elderly patients presenting with gastric ulceration.