Gastrocolic Fistula Research Articles

Endoscopic ultrasound-guided gastroenterostomy for the treatment of gastric outlet obstruction secondary to acute pancreatitis.

Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a minimally invasive technique for treating gastric outlet obstruction (GOO). The aim of this study was to assess the outcomes of EUS-GE in managing benign GOO caused by duodenal stenosis in patients with acute pancreatitis. This international retrospective study analyzed patients treated with EUS-GE for GOO caused by acute pancreatitis until December 2023, evaluating technical and clinical success, adverse events, and reintervention. 39 patients (median age 55 years, 15 women) were included. There was a 92.3% technical success rate, with only three patients unable to undergo EUS-GE owing to a long distance between the stomach and small bowel or an inadequate window for puncture. Clinical success was observed in 34 patients (87.2%). The median Gastric Outlet Obstruction Scoring System (GOOSS) improved from 0 before EUS-GE to 2 afterward (P <0.001). Follow-up (≥3 months) was available in 25 patients. During a median follow-up of 23 months, four patients required reintervention. It was possible to remove the lumen-apposing metal stent in 18 patients. The only adverse event was a gastrocolic fistula detected incidentally after 3 months. EUS-GE is an effective and safe method for managing benign GOO in the setting of acute pancreatitis.

Rare Complications Following Laparoscopic Sleeve Gastrectomy.

Metabolic and bariatric surgery (MBS) is the most effective and durable therapeutic intervention for patients with obesity. In recent years, laparoscopic sleeve gastrectomy (SG) has become the most commonly performed primary MBS procedure owing to its technical feasibility and excellent short-term outcomes. Despite these favorable results and perceived advantages, SG is associated with several unique complications. Complications such as a postoperative leak or bleeding have been more commonly observed and reported than others, and their management approaches are well described. However, other complications following SG are far less familiar to surgeons, which may delay recognition and result in poor patient outcomes. Of these complications, we describe splenic injuries; esophageal perforation; staple line malformations; stapling of intraluminal devices; phytobezoar formation; gastro-colic, gastro-pleural and gastro-bronchial fistula; pancreatic leak; and portomesenteric venous thrombosis. It is paramount for surgeons to be aware of these underreported issues and have the resources to learn how to recognize and manage them when they arise. This review aims to describe rare (i.e., reported incidence <1%) and underdescribed complications after SG, focusing on causes, clinical presentation, prevention strategies, and management.

Percutaneous Gastrostomies: Associated Complications in PUSH vs. PULL Techniques over 12 Years in a Referral Centre.

Objectives: To compare complications associated with percutaneous gastrostomies performed using PUSH and PULL techniques, whether endoscopic (PEG) or radiological (PRG), in a tertiary-level hospital. Methods: This was a prospective observational study. Adult patients who underwent percutaneous PULL or PUSH gastrostomy using PEG or PRG techniques at the Virgen del Rocio University Hospital and subsequently followed up in the Nutrition Unit between 2009-2020 were included. X2 tests or Fisher's test were used for the comparison of proportions when necessary. Univariate analysis was conducted to study risk factors for PRG-associated complications. Results: n = 423 (PULL = 181; PUSH = 242). The PULL technique was associated with a higher percentage of total complications (37.6% vs. 23.8%; p = 0.005), exudate (18.2% vs. 11.2%; p = 0.039), and irritation (3.3% vs. 0%; p = 0.006). In the total sample, there were 5 (1.1%) cases of peritonitis, 3 (0.7%) gastrocolic fistulas, and 1 (0.2%) death due to complications associated with gastrostomy. Gender, age, and different indications were not risk factors for a higher number of complications. The most common indications were neurological diseases (35.9%), head and neck cancer (29%), and amyotrophic lateral sclerosis (17.2%). Conclusions: The PULL technique was associated with more total complications than the PUSH technique, but both were shown to be safe techniques, as the majority of complications were minor.

Gastrocolic fistula as a complication of a gastric ulcer related to Helicobacter pylori in a child

Gastrocolic fistulas are very rare in children and their association with Helicobacter pylori is poorly described. We present the case of a 10-year-old boy with a history of chronic abdominal pain, diarrhea, halitosis, and growth delay diagnosed with H. pylori-associated gastritis and gastrocolic fistula. The boy recovered with resection surgery and antibiotic therapy for eradication of the pathogen. This is the first description of a gastrocolic fistula in pediatrics related to H. pylori.

Gastrostomies: experience and complications with three modalities in a tertiary centre over a 26-year period.

To describe the complications associated with the different gastrostomy techniques [endoscopic (PEG), radiologic (PRG), and surgical (SG)] performed in the last 26 years in a terciary hospital. Retrospective observational study. Patients who underwent gastrostomy at the Virgen del Rocío University Hospital between 1995 and 2021 were included. For PEG, the PULL technique was performed until 2018 and subsequently the PUSH technique predominantly. For PRG, a pigtail catheter was used until 2003, a balloon catheter between 2003 and 2009, and a balloon catheter with gastropexy between 2015 and 2021. For SG, the conventional technique (CSG) was performed until 2009 and since then the laparoscopic assisted percutaneous gastrostomy (PLAG) technique. Descriptive analysis was performed obtaining the median and quartiles of the quantitative variables [P50 (P25-P75)] and the frequency for the qualitative variables [n (%)].The comparison of complications between patients who underwent different techniques was performed with Fisher's test. n = 1,070 (PEG = 608, PRG = 344, SG = 118). The three most frequent indications were head and neck tumors, neurological diseases and gastroesophageal tumors. The percentage of patients who had any complication was 48.9% (PEG-PULL), 23.7% (PEG-PUSH), 38.5% (pigtail PRG), 39.2% (balloon PRG), 29.7% (balloon with gastropexy PRG), 87.3% (CSG), and 41.26% (PLAG). 2 (0.18%) patients died from gastrostomy-related complications. 18(1.68%) presented with peritonitis and 5 (0.4%) presented with gastrocolic fistula. The rest of the complications were minor. Gastrostomy in any of its modalities is currently a safe procedure with a low rate of complications, most of which are minor.

S4156 Findings of Gastrocolic Fistula in a Middle-Aged Female

S4156 Findings of Gastrocolic Fistula in a Middle-Aged Female

Gastrocolic fistula caused by transverse colon cancer: a case report

BackgroundA gastrocolic fistula is an unusual communication between the colon and the stomach. Although colon cancer is the most common malignant cause of gastrocolic fistula in the Western world, the incidence of gastrocolic fistula due to colon cancer is 0.3% in operated cases.Case presentationA 68-year-old man presented with anorexia, general malaise, weight loss, and vomiting of fecal matter. Investigations revealed that the patient had a large nonmetastatic splenic flexure tumor that was diagnosed as colon cancer and had invaded the stomach and pancreas. An upper gastrointestinal series confirmed a gastrocolic fistula. Left hemicolectomy, distal gastrectomy, distal pancreatectomy, and splenectomy were performed. Histology revealed transverse colon cancer, which was UICC stage (8th edition) pT4bN1bcM0 pStage IIIC. Adjuvant chemotherapy was not performed. There was no recurrence or metastasis one year after surgery.We reviewed 17 cases including our case of a gastrocolic fistula caused by colon cancer. Neoadjuvant chemotherapy was not given to any of the patients, and en bloc resections were conducted in all cases. Adjuvant chemotherapy was given to almost all of the patients. There was no recurrence or metastasis.ConclusionsFor gastrocolic fistula caused by advanced colon cancer, secure en bloc surgical resection was the initial treatment in all 17 reported cases including the present case, and adjuvant chemotherapy may contribute to a better prognosis.

Gastro-colic Fistula-associated Hypersplenism Causes Pancytopenia in a Patient with Crohn's Disease: A Case Report.

A 24-year-old woman was admitted to our hospital due to abdominal pain and a high fever. She was diagnosed with ileocolonic Crohn's disease (CD), complicated with a gastro-colic fistula and splenomegaly. After initial treatment with an infliximab-biosimilar, all blood cell line counts markedly decreased. Three-dimensional reconstructed computed tomography revealed splenic vein narrowing. Thus, her pancytopenia was deemed to have likely been caused by hypersplenism. Surgery was performed, and clinical remission was maintained without pancytopenia. This is the first report of a CD patient with pancytopenia caused by hypersplenism that was triggered by gastro-colic fistula-associated splenic vein obstruction.

Transvaginal fecal leak, an unusual presentation of a gastrocolic fistula, a case report.

Transvaginal fecal leak, an unusual presentation of a gastrocolic fistula, a case report.

Gastrocolic Fistula: An Extraordinary Gastrointestinal Fistula.

Gastrocolic (GC) fistula, a rare gastrointestinal pathological condition, is defined as an abnormal connection between the stomach and the colon. Mostly, it involves the greater curvature of the stomach and the transverse part of the colon. Its precise incidence rate is unknown and largely differs between western and eastern nations. Etiological causes differ as well between the two worlds. Although several precipitating diseases are reported, nowadays, the most common causes are malignant diseases of the stomach (eastern countries) and colon (western world). Patients with GC fistulas usually present late and complain mainly of vomiting, diarrhea, and severe weight loss. This in turn leads to malnutrition, vitamin deficiencies and electrolyte disturbances. Being a rare condition, and usually forgotten, diagnosis is usually challenging to the treating physicians. Workup usually involves a combination of radiological and endoscopic tests. Long-term survival is unknown, and patients usually have poor prognosis. The aim of this review is to summarize the relevant articles in the English literature for this abnormal medical condition, with emphasis on the different etiologies, pathogenesis, clinical presentation, and management, in order to increase physicians' awareness of such uncommon medical problem.

Life-threatening bowel complications following anti-tumor necrosis factor antibody therapy for patients with inflammatory bowel disease

Incidence of inflammatory bowel disease (IBD) in Taiwan and the experience of the management of serious complications is much lower than in Western countries. The authors just want to alert readers that anti-tumor necrosis factor (TNF) is not without life-threatening complications. Three serious complications were described, including surgical management and outcomes following the application of anti-TNF monoclonal antibody therapy for IBD. Case 1 involved a 25-year-old man treated with five doses of adalimumab for moderate control of Crohn's disease (CD). Six months later, he experienced severe intestinal obstruction, which necessitated right hemicolectomy with ileocolic anastomosis. He recovered postsurgery. Case 2 involved a 54-year-old man treated with adalimumab for intractable ulcerative colitis. Ten days after the second dose of adalimumab, an emergent subtotal colectomy with ileostomy was performed for a transverse colon perforation with peritonitis. The patient underwent an ileal pouch operation a year later. Case 3 was based on a 16-year-old male patient treated with six doses of an infliximab biosimilar for CD; thereafter, an emergent subtotal colectomy with ileostomy and Hartmann's pouch was performed for peritonitis with the presence of a perforated gastrocolic fistula tract. He had no serious complications following an uneventful recovery period. Creating awareness of serious complications associated with biologic treatments and offering appropriate patient management, including surgical treatment, is beneficial to patients.

Multidisciplinary management of gastrocolic fistula post ingestion of multiple magnetic beads: a case report

Foreign body ingestion is quite common in pediatric population, and these cases are usually difficult to manage due to delay in diagnosis. Ingestion of multiple magnetic foreign bodies together is very dangerous and can lead to serious complications like bowel obstruction, fistula and even death. Urgent endoscopic retrieval followed by surgical exploration, if required remains the best approach for removing multiple ingested magnets, thus preventing further injury to the gastrointestinal tract. We report a case of a 2-year-old child who developed a gastrocolic fistula following the ingestion of multiple magnetic beads, which remained undiagnosed weeks after ingestion. Most of the magnetic beads were successfully retrieved endoscopically, however a few remained despite extensive search. Hence the patient underwent emergency laparotomy which showed a gastrocolic fistula, was subsequently repaired after removal of remaining magnetic beads remaining magnetic beads from the colon.

S3617 Gastrocolic Fistula After Roux-en-Y Gastric Bypass: A Case Report

Introduction: Gastric Fistula is a well-recognized complication after Roux-en-Y gastric bypass (RYGB). We present a rare case of gastro-colic fistula that occurred many years following a RYGB. Case Description/Methods: Our patient is a 68-year-old female nursing home resident with a past medical history of hypertension, diabetes, stroke, chronic ventilator-dependent respiratory failure and retrocolic RYGB surgery in 2001 who presented with dark maroon stool. The patient’s vitals were stable, abdominal exam was benign, and she had a gastrostomy tube in place (remnant stomach). Laboratory workup showed a Hgb of 6.4 mg /dl. Upper endoscopy showed ulceration and stenosis of gastro-jeujenostomy and gastro colic fistula. The fistula was intubated and showed feculent material from the transverse colon(Figure A,B). The biopsies of the ulcers revealed chronic inflammation. Computed tomography (CT) imaging with oral and IV contrast showed contrast filling in transverse colon and changes consistent with gastro colic fistula(Figure C,D). General surgery and bariatric surgery were consulted. However, she was not a candidate for surgical intervention due to her overall condition. She was discharged to a nursing home after management with a proton pump inhibitor (PPI) along with a blood transfusion. Discussion: Fistulous complications occur in up to 1- 6% of patients who undergo RYGB surgeries. This is historically related to incomplete division of gastric tissue upon creation of gastric pouch. However, with new stapler technology, the staple line is completely divided and the chances of fitulous complications are signficantly decreased. Gastro-jeujenal anastomosis ulcer, leaks, and chronic infection might be contributing to contemporary fistulas. Like ulcers, most gastro gastric fistulas present with epigastric abdominal pain, oral intolerance, failure to thrive and/or bleeding. The patient was not a candidate for surgery due to her overall medical condition. Had the patient been a surgical candidate, exploratory laparoscopy with en-bloc resection of the fistula and reconstruction would have been the definitive surgical treatment for her gastro colic fistula. It is strongly recommended that clinicians take a multi-disciplinary approach to this rare, but critical complication of bariatric surgery to ensure overall patient health optimization.Figure 1.: (A) Gastric pouch to transverse colon fistula, (B) Contrast seen in descending colon, (C) Gastric pouch to transverse colon fistula, (D) Transverse colon visualized through the fistulous tract.

Safety of teaching endoscopic ultrasound-guided gastroenterostomy (EUS-GE) can be improved with standardization of the technique.

Abstract Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel technique developed to manage gastric outlet obstruction (GOO). It involves creating a fistula between the stomach and the proximal small bowel using an electric cautery-enhanced lumen-apposing metal stent (ECE-LAMS) with EUS guidance. We aimed to publish our experience in improving teaching of this technique to practicing endoscopists with a wide range of experience by comparing the outcomes before and after standardization of procedural steps. Methods All EUS-GEs performed for inoperable GOO at a single institution from 2014 to 2021 were retrospectively analyzed. The technique was taught by one experienced endoscopist with prior expertise. Five advanced endoscopists with prior EUS and ECE-LAMS placement experience participated. The impact of standardization on outcomes (clinical and technical success, length of stay [LOS], procedure time, and adverse events [AEs]) was compared. Results A total 41 EUS-GEs were performed (5 before and 36 after standardization) by endoscopists with practice experience ranging from 2 to 13 years. The patient population was similar in age and sex. Standardization was associated with significantly higher rates of technical success (100 % vs 60 %, P = 0.01) and lower peri-procedural AEs (2.8 % vs 40 %, P = 0.03). Two AEs in the pre-standardized group were gastric perforation and gastrocolic fistula creation. One AE in the post-standardized group was gastric perforation. Procedure time, clinical success, and LOS showed improvement, although it was not statistically significant. Conclusions Teaching EUS-GE after standardizing the procedure was associated with a significant increase in technical success and a decrease in AEs irrespective of prior total experiences.

Gastrointestinal fistula due to multiple neodymium magnet ingestions

Foreign body ingestion (FBI) is one of the critical conditions encountered in pediatric emergency services. FBI can lead to high mortality in children. Neodymium magnets are increasingly popular due to children’s great interest in them. In cases of multiple magnet ingestion, the risk of mucosal perforation is higher when compared with other types of FBI. With this case, an attempt to raise awareness of this medical problem was made by sharing the case of a neodymium magnet body in a 24-month-old patient. The magnet was detected incidentally during our fever etiology examination although possible ingestion of a foreign body had previously been reported in her medical history. Our patient presented with abdominal tenderness, agitation, and other symptoms. An abdominal X-ray was taken. A foreign body that resembled a neodymium magnet sphere was observed. During surgery, a gastrocolic fistula in the antrum was observed. Multiple magnets are foreign bodies that present a higher risk of causing intestinal perforation compared to other foreign bodies. It is known that multiple magnet ingestions may cause mucosal ulceration, and it should be emphasized that such ingestion may cause gastrointestinal fistulas. Since pediatric patients in a certain age group tend to put objects in their mouths, each patient with an unclear cause of fever and abdominal sensitivity should be questioned with respect to FBI and then tested radiologically.

Gastrocolic fistula, a rare complication of repeated gastric surgery.

Gastrocolic fistula, a rare complication of repeated gastric surgery.

Role of Endoscopic Internal Drainage in Treating Gastro-Bronchial and Gastro-Colic Fistula After Sleeve Gastrectomy.

Gastro-bronchial and gastro-colic fistulas (GB-GC) represent a rare, but serious complication after laparoscopic sleeve gastrectomy (LSG). The aim of this study is to evaluate the efficacy of endoscopic first-line approach with endoscopic internal drainage (EID) by inserting double pigtail stents (DPS) METHODS: We retrospectively analyzed data from 40 consecutive patients referred at two tertiary centers for gastro-bronchial (N=30) and gastrocolic (N=10) fistulas following LSG. Nineteen patients previously experienced emergency surgical drainage. The mean interval between the index surgery and endoscopic fistula treatment was 265.6±521 days. Healing of the fistulous tract was achieved in 19 patients (47.5%), with complete resolution at an average follow-up of 16 months. Mean time of treatment duration was 157.8±141 days with 5.0±2.9 endoscopic sessions. No major adverse events were registered. Despite complete fistula healing was achieved in less than 50% of our population, EID for GB/GC fistula after LSG still represents the most conservative approach with low complications rate. Previous surgical drainage seems to be a positive prognostic factor for endoscopic healing. While the longer the interval between the index surgery and endoscopic treatment, the lower was the rate of treatment success.

Percutaneous Endoscopic Gastrostomy Tubes Can Be Considered Safe in Children: A Single-Center 11-Year Retrospective Analysis.

Background and Objectives: When the human body is disabled to naturally ingest food through the mouth, enteral or parenteral nutritional support should be started. Percutaneous gastrostomy (PEG) is a flexible feeding tube that is inserted into the stomach through the abdominal wall in patients who will need long-term enteral nutrient intake. The aim of this study is to analyze clinical characteristic of children at the time of PEG placement as well as to determine indications, complications and outcomes associated with PEG at the Department of Pediatrics of the University Hospital of Split. Materials and Methods: Retrospective analysis of the medical records of patients treated from 2010 to 2020 was performed. The following data were collected from medical records: age, gender, information about nasogastric feeding before PEG placement, indication for PEG insertion, duration of PEG, procedure-related complications and treatment outcomes. Malnutrition was determined according to the z-score range for BMI for age and sex. According to the indication for PEG placement, patients were divided into five categories: central nervous system (CNS) diseases, neuromuscular diseases, genetic disorders, metabolic diseases, and group of children with polytrauma. Results: A total of 40 patients with median age of 110 months were included in study. At the time of PEG placement, most patients had deviations in body weight and height compared to expected values for age and sex. The most common underlying diagnoses were diseases of the central nervous system. Minor complications were found in 13 (35%) of patients. One patient (2.7%) developed major complication (gastrocolic fistula) and consequently underwent reoperation. The median duration of PEG in patients with complications before the need for replacement was 27 months, and in patients without complications, 43 months. Conclusions: Negative deviations of z-score body weight, body height, and body mass index could indicate the need for possible earlier placement of PEG. PEG can be considered as a safe therapeutic option in children since PEG-related complications, mostly in minor forms, were found in a small number of patients.

Synchronic finding of a foreign body in colon and a malignant gastrocolic fistula

Synchronic finding of a foreign body in colon and a malignant gastrocolic fistula

S3131 An Unusual Case of Postprandial Diarrhea: Gastrocolic Fistula from Gastric Band Erosion

Introduction: Bariatric surgery is increasingly performed nowadays. Gastroenterologists may encounter patients with its complications. Known complication of laparoscopic adjustable gastric banding (LAGB) include reflux, band slippage, erosion, pouch enlargement, and port breakage. We report a case with an unusual complication of LAGB. Case Description/Methods: A 45-year-old male with LAGB and atrial fibrillation presented with chronic diarrhea. Symptoms onset was 3 years ago after his partial small bowel resection when he presented with peritonitis. The patient reported loose stool within 15 minutes after each meal, abdominal pain, and 13-lbs weight loss. Physical exam was unremarkable. Laboratory data were within normal limits except mild anemia (Hgb of 12.9 g/dL) and mild renal impairment (Cr of 1.55 mg/dL). Upper GI study with small bowel follow through showed two separate channels arising from the proximal stomach with one connecting to the mid-transverse colon, suggesting a gastrocolic fistula (GCF) (figure 1A). CT scan of chest/abdomen/pelvis that was performed prior to barium studies was reviewed and demonstrated gastric erosion of the LAGB, with tethering of gastric cardia to the transverse colon with prolapse of the tubing into the distal transverse colon (figure 1B). Subsequent upper endoscopy showed an eroded gastric band in the gastric cardia and appeared to be extending through the gastric wall (figure 1C). Colonoscopy noted gastric band was entering transverse colon and extended distally (figure 1D). Surgical specimen of previous small bowel resection was reviewed and didn't show small bowel ischemia nor small bowel Crohn’s disease. The patient is currently evaluated by a bariatric surgeon for the definite treatment. Discussion: GCF is an uncommon manifestation of certain malignancies, pancreatitis, Crohn’s disease, peptic ulcer disease, and few cases related to other bariatric surgeries, usually with sleeve gastrectomy. LAGB related erosions of stomach, colon, and small bowel have been reported. To best of our knowledge, there are only 3 other cases of GCF related to LAGB. We report a rare complication of LAGB. Mechanism of GCF from LAGB is not fully understood, and is likely related to erosion of gastric wall from band pressure or foreign body reaction. Symptoms includes abdominal pain, weight loss, diarrhea, and sepsis. Diagnosis is made with upper GI series, contrast enhanced CT and endoscopic visualization. Surgery is the mainstay of treatment with removal of band and closure of fistula.Figure 1.: Endoscopic image of gastric ulcer in first case (A). Microscopic image H&E stained 400x of lymphoepithelial lesion with surrounding lymphocyte mucosal invasion (B). Endoscopic image of polypoid lesion in second case (C). Microscopic image H&E stained 200x of diffuse lymphocyte invasion into the lamina propria and muscularis mucosa (D).