Int J Surg Case Rep. 2014;5(12):995-7. doi: 10.1016/j.ijscr.2014.09.013. Epub 2014 Oct 23.

Malignant sigmoidoduodenal fistula.

International journal of surgery case reports

I M Shapey, K Mahmood, M H Solkar

PMID: 25460456 PMCID: PMC4275860 DOI: 10.1016/j.ijscr.2014.09.013

Abstract

INTRODUCTION: Duodenocolic fistula is a rare complication of malignant colonic disease especially when involving and originating from the sigmoid colon. We aim to discuss the unusual clinical presentation of this case as well as the investigation and management of duodenocolic fistulas.

PRESENTATION OF CASE: A 91 year old lady presented as an emergency to a general surgical service at a District General Hospital with diarrhoea, vomiting and weight loss. Computed Tomography (CT) reported a large ovarian cyst elevating the sigmoid colon into immediate proximity of the duodenum. Adenocarcinoma was confirmed on histology obtained by colonoscopy. A classic apple core lesion with fistulating tract from the sigmoid colon to the duodenum was synchronously demonstrated on barium enema.

DISCUSSION: Sigmoido-duodenal fistulae represent a complex manifestation of gastrointestinal pathologies.

CONCLUSION: Management options must be considered in the context of patient wishes, their co-morbidities, and predicted post-operative outcome. In most cases this is likely to represent a non-operative approach, however surgical resection may benefit selected cases on occasion.

Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Keywords: Colorectal cancer; Duodenocolic fistula; Sigmoidoduodenal fistula

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Publication Types

• Journal Article