Malignant Duodenocolic Fistula Research Articles

Malignant duodenocolic fistula successfully treated with self-expandable partially covered metal stent and endoscopic suturing.

Malignant duodenocolic fistula successfully treated with self-expandable partially covered metal stent and endoscopic suturing.

Malignant duodenocolic fistula as a form of presentation of right colon cancer. Case report

Malignant duodenocolic fistula in an unusual presentation internal fistula, whose main symptoms are abdominal pain, weight loss, halitosis, fecaloid vomiting and diarrhea. We report the case of a 79-year-old patient with diarrhea, fecaloid vomiting and significant weight loss, who is surgically intervened with the diagnosis of duodenocolic fistula, performing right hemicolectomy, partial duodenectomy, transverse duodenorphy as definitive treatment.

MALIGNANT DUODENOCOLIC FISTULA- CASE REPORT OF RARE COMPLICATION OF COLONIC CANCER TREATED BY MULTIVISCERAL RESECTION

Duodenocolic fistulas created by invasive cancer of the colon are rare complications. They are presented with serious electrolytic and nutritional disturbances due to vomiting, diarrhoea, abdominal pain, GI bleeding, and weight loss. Case report: In this paper we present young male patient with malignant duodenocolic fistula between ascendant colon and D2 portion of duodenum and pancreatic head, treated with right hemicolectomy and pancreaticoduoedenectomy. Postoperative histopathology confirmed poorly differentiated colonic adenocarcinoma without spreading to lymph nodes and major vessels. Patient is still alive after three years of the operation which led as to conclusion that this type of radical operation may represent one of the best treatments for this rare complication, provides good quality of life and is prognostically justifiable. Keywords: malignant duodenocolic fistula, advanced colorectal carcinoma (CRC), right hemicolectomy, pancreaticoduoedenectomy.

Malignant Duodenocolic Fistula Diagnosed by Endoscopy: A Report of Two Cases

Malignant Duodenocolic Fistula Diagnosed by Endoscopy: A Report of Two Cases

Surgical approach for tumours of the third and fourth part of the duodenum. Distal pancreas-sparing duodenectomy

The anatomic complexity of the duodenum makes surgical resection challenging. We describe our experience with distal pancreas-sparing duodenectomy (PSD) for tumours that arise in the third and fourth parts of the duodenum. Between July 2008 and January 2012 eight patients underwent surgical resection for tumours in the distal parts of the duodenum. Short and long-term outcomes of treatment are retrospectively analyzed. We used the Cattell and Braash surgical approach in six patients. Seven patients underwent a segmental resection of the distal duodenum with a duodenojejunal anastomosis and in one case we performed a wedge local excision with primary closure. There were 5 gastrointestinal stromal tumours (GIST), 1 primary duodenal adenocarcinoma, 1 metastasis of a lung adenocarcinoma and 1 patient with malignant duodenocolic fistula caused by advanced sigmoid colon carcinoma. Median operating time was 200 min and median intraoperatory blood loss 162 mL. Three patients showed postoperative complications and one of them died. There was no reoperation. Median hospital stay was 10 days (range, 7–28 days). The patient with primary adenocarcinoma died after 12 months due to hepatic metastases. All of five patients with GIST are alive without recurrence (mean follow up of 65.6 months), as well as the patient with metastatic duodenal infiltration (45 months after surgery). Segmental resection of the third and fourth portions of the duodenum is reliable and feasible. The Cattell and Braash manoeuvre provides a good exposure and makes this kind of resection easier.

Malignant Duodeno-Colic Fistula: A Rare Complication of Colorectal Cancer

The incidence of small bowel and colorectal cancer (CRC) is escalating worldwide [1,2] and there is a corresponding rise in cancer-related complications [3]. Unlike CRC, small bowel cancer is very aggressive tumour which spreads and metastasizes rapidly. Often, small bowel cancer is diagnosed after it has metastasized. One of the rare complication of locally advanced CRC is malignant duodeno-colic fistula (MDCF) with a reported incidence of 0.14% [4]. Although there have been isolated reports of MDCF [5], the incidence of this condition remains low due to its early detection by the use of advanced imaging, endoscopic, and screening modalities. Other rare causes of MDCF include carcinoma of gall bladder, duodenal carcinoma and metastatic cancer of oesophagus. This article exclusively describes MDCF as a rare complication of CRC. A brief account about the uncommon and vague clinical features, some diagnostic modalities and management strategies are outlined. MDCF can present with symptoms from the primary tumour (diarrhoea, weight loss, abdominal pain and vomiting), from the fistula (lower GI bleeding) or from metastatic disease [6]. Diarrhoea occurs due to bacterial contamination of duodenum leading to malabsorption of food contents in the upper intestine. Imaging like CT scan and barium meal can identify fistulous track as well as the primary tumour. CT scanning explicitly delineates metastatic spread as well as the extent of local invasion. Treatment of MDCF depends on general condition of patient, extent of local invasion of primary tumour and metastatic status of CRC. Preoperative optimization is done by correction of fluid and electrolyte disturbances, total parenteral nutrition, and blood transfusion. As for primary CRC [7], surgical therapy is considered to be the standard curative treatment modality for MDCF. The anatomical complexity of duodeno-pancreatic area poses a challenge to surgical approach and the situation can be further compounded by local invasion of major vessels. Right hemicolectomy with either partial duodenenctomy and primary closure of duodenal wall defect or the use of jejeunal loop have been proposed as surgical procedures with curative intent [8,9]. In Japan, Izumi examined 34 cases of MDCF treated by en bloc pancreaticoduodenectomy and reported their survival rate of 7 days to 4 years (median=10 months) [10]. A 5-year survival rate, in patients with nodal metastasis, has been shown to be 0-11% that is significantly lower than the 37-76% survival rate in their patients without nodal metastases [11]. Postoperative complications such as intra-abdominal abscess, bile duct necrosis, septic shock, anastomotic leakage and lower GI haemorrhage can be expected after surgical treatment. For incurable and metastatic MDCF, a bypass procedure of ileo transverse anastomosis with gastrojejunostomy offers a reasonable palliative surgical modality. Early detection of CRC by CT scan, colonoscopy, and various screening tools carries the best chance in preventing the development of complications. MDCF from colonic primaries can be treated by curative surgery that offers good prognosis when diagnosed at an early stage [12]. Once diagnosed, en bloc surgical removal and closure of the duodenal wall defect is recommended surgical option for MDCF. Chemotherapy or radiotherapy have no role in the management of MDCF.

Malignant Duodeno-Colic Fistula

Malignant Duodeno-colic fistula is a very rare complication of malignancies of colon, duodenum, pancreas or gallbladder. The passage of hydrochloric acid and bile salts from duodenum into the colon has an irritative effect on the colonic mucosa resulting in diarrhea. The diagnosis is established with upper and lower gastrointestinal tract contrast studies. We report a case of Duodeno-colic fistula secondary to an adenocarcinoma of hepatic flexure. Extended right hemicolectomy with Whipple's procedure was done.

Extended right hemicolectomy; the treatment of advanced carcinoma of the hepatic flexure and malignant duodenocolic fistula.

Journal Article Extended right hemicolectomy the treatment of advanced carcinoma of the hepatic flexure and malignant duodenocolic fistula Get access H W Gallagher H W Gallagher Banbridge Hospital, Banbridge, Co. Down, Northern Ireland Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 47, Issue 206, May 1960, Pages 616–621, https://doi.org/10.1002/bjs.18004720606 Published: 14 December 2005

Placement of a covered metal stent via gastrostomy for management of malignant duodenocolic fistula with duodenal obstruction

Placement of a covered metal stent via gastrostomy for management of malignant duodenocolic fistula with duodenal obstruction

Endoscopic diagnosis of malignant enterocolic fistula caused by ileal lymphoma

Malignant fistula of the GI tract is a rare clinical condition. Although this complication could readily be diagnosed by radiographic imaging, colonoscopy has also been diagnostic. 1 Matsumoto T Iida M Kuwano Y Furuse M Kimura Y Fujishima M Endoscopic demonstration of malignant duodenocolic fistula: two case reports. Endoscopy. 1996; 28: 268 Crossref PubMed Scopus (1) Google Scholar , 2 Roberts PL Coller JA Corriveau S Nielsen-Whitcomb FF Malignant duodenocolic fistula diagnosed by endoscopy. Surg Endosc. 1989; 3: 112-114 Crossref PubMed Scopus (4) Google Scholar , 3 Becheur H Piketty C Bloch F Levoir D Aubertin JM Bouillot JL et al. Endoscopic diagnosis of a duodenocolic fistula due to a non-Hodgkin's lymphoma in a patient with AIDS. Endoscopy. 1996; 28: 528-529 Crossref PubMed Scopus (3) Google Scholar No previous reports have described enteroscopic features of malignant enterocolic fistula. We herein report a rare case of ileal lymphoma with an enterocolic fistula that was confirmed by ileoscopy and colonoscopy.

Ileal Conduit for Reconstruction of the Duodenum following Right Hemicolectomy and Pancreaticoduodenectomy for Malignant Duodenocolic Fistula

We describe a case of malignant duodenocolic fistula in which after a radical resection of right hemicolectomy and pancreaticoduodenectomy, the duodenal defect was reconstructed using a conduit of transposed ileum. This technique, not previously described, offers an alternative to 'duodenal patching', which allows only limited duodenal resection, or gastroenterostomy with its attendant side-effects such as dumping syndrome.

Malignant Duodenocolic Fistula

Malignant duodenocolic fistula is a seldom-seen complication of advanced right colon carcinoma. We describe four patients who illustrate the sometimes rewarding results of aggressive treatment. Because duodenocolic fistula is always associated with severe nutritional impairment, operation should be deferred until total parenteral nutrition (TPN) and blood transfusions have improved the clinical state. Whenever feasible, resection offers the best treatment; lesser techniques such as bypass and exclusion result only in minimal palliation. A direct approach and fistula disconnection are contraindicated. The benefit of exploration should almost always be offered, even in such secondary fistulas, as a better quality of life and long-term survival are realistic goals.

A CASE REPORT OF COLON CANCER CURATIVELY RESECTED BY PYLORUS-PRESERVING PANCREATODUODENECTOMY AND RIGHT HEMICOLECTOMY

A case of colon cancer with malignant duodenocolic fistula which was curatively resected by pylorus-preserving pancreatoduodenectomy (PPPD) and right hemicolectomy is described. A 60-year-old man complained of vomiting and diarrhea. Barium meal, barium enema, computed tomography and other radiological examinations were performed, and the patient was diagnosed as having a carcinoma of the transverse colon with direct invasion to the third portion of the duodenum and malignant duodenocolic fistula. Right hemicolectomy and PPPD were performed at a time to achieve en-bloc resection of the lesion with regional lymph nodes dissection. Microscopic examination showed no lymph node metastasis. We could perform absolute curative resection. Postoperative course was uneventful, and he is getting well as of one year after the operation, with good nutritional state and no evidence of recurrence.In this paper our indications, some devices for surgical technique and postoperative management of PPPD, as well as importnat points for surgical procedure applied to this case are discussed.

Malignant Duodenocolic Fistula

A 49-year-old woman with a malignant duodenocolic fistula of colonic origin underwent a one-stage right hemicolectomy and pancreatoduodenectomy. The postoperative course was uneventful. She is doing well 3.9 years after the surgery without any finding of recurrence.

Malignant duodenocolic fistulas

Five cases of malignant duodenocolic fistula seen at the Massachusetts General Hospital in the past thirty years are reviewed. Rarely encountered, these lesions are characterized by diarrhea, weight loss, abdominal pain, anemia, and sometimes feculent vomiting. Barium enemas are more likely to demonstrate the fistula tract than upper gastrointestinal series. Nutritional deficiencies may be profound, and the use of preoperative hyperalimentation is encouraged. Operations that accomplish only bypass of the fistula are of minimal palliative value, and the fistula should be divided or resected if possible. When feasible, wide resection is the procedure of choice, and a fourteen year survival is reported after this operation.

Duodenal fistula: With special reference to choledochoduodenal fistula complicating duodenal ulcer

The subject of duodenal fistula has been reviewed. During a fifteen-year period at Charity Hospital and Touro Infirmary, New Orleans, Louisiana, forty-three duodenal fistulas were recorded with a 37.2 per cent mortality. Four deaths occurred in twenty-one internal fistulas and twelve deaths in twenty-two external fistulas. There was a 66.6 per cent mortality in the end type of external fistula. The average onset of the end type of fistula was eight days after surgery. This type occurred more frequently in men. There was a 40 per cent mortality in the lateral type of external fistula. The average onset of the lateral type was five days after surgery. No sex preponderance was noted in this type. Interruption of intestinal continuity produced by external duodenal fistula leads to loss of contents and destruction of the abdominal wall. Adequate replacement of fluids and electrolytes and constant removal of drainage from the fistula by suction are important considerations in the care of these patients. Internal duodenal fistulas often communicate with the gallbladder. Rarer is the choledochoduodenal fistula which usually arises from duodenal ulcer which perforates onto the common duct. Most duodenocolic fistulas are due to carcinoma. Slightly less frequent in causation is duodenal ulcer. The demonstration of duodenocolic fistula is best accomplished by barium enema. The treatment of malignant duodenocolic fistula is radical resection in one or two stages, and duodenocolic fistula due to benign ulcer, subtotal gastrectomy and closure of colonic opening. Regurgitation of duodenal contents into the common duct is ordinarily prevented by the oblique course of the common duct through the pancreas and duodenal wall, the valve-like folds in the ampulla of Vater and the sphincter of Oddi. The presence of air in the biliary tract is of great value in diagnosis of patients who are seen for the first time during the phase of intestinal obstruction since gallstone ileus usually has its beginning with a duodenobiliary communication. The possibility of developing an abnormal communication between the biliary tract and duodenum due to biliary tract disease is a strong argument for removal of the gallbladder in all cases of cholelithiasis. Once the fistula is present, it must be attacked, the opening in the bowel closed, gallbladder removed and the common duct explored. Five case reports of choledochoduodenal fistula complicating duodenal ulcer are presented. There is a twofold problem in the management of this condition: to rid the patient of his fistula and to cure him of his ulcer. The preferred method of handling the fistula would appear to be reimplantation of the common duct into the duodenum or jejunum, and subtotal gastrectomy combined with vagotomy.