Gastrojejuno-colic fistula after gastrojejunostomy
A 55-year-old man was admitted to the medical center at Dankook University Hospital in December 2011. The patient had complaints of chronic watery diarrhea that occurred immediately after meals for 6 months, general weakness, and a weight loss of 15 kg during a 3-month period. Past medical history revealed primary repair for duodenal ulcer perforation in 1982 and truncal vagotomy and gastrojejunostomy in 1996 due to gastric outlet obstruction. The patient was cachectic and dehydrated. Laboratory parameters revealed malnutrition with albumin level of 2.6 g/dL (range, 3.4 to 4.8), protein level of 4.3 g/dL (range, 6.4 to 8.3), and cholesterol of 72 mg/dL (range, 120 to 239). Simple abdomen X-ray film was unremarkable.\nThe infusion of contrast into the colon was identified near the gastrojejunostomy, according to a thin barium UGIS double study (). Copious fecal fluid was evident in the stomach through a gastroscopy, and a canal was identified in the previous gastrojejunostomy site and low body posterior wall connected directly to the colon (). A colonscopy revealed an anastomosis site was seen in the transverse colon stricture and T-colon connected to the stomach.\nAfter improving the patient's state of malnutrition and his weight through total parenteral nutrition (TPN), the patient was taken into the operation room and an exploratory laparotomy was undertaken. In surgery, the gastrojejunostomy site and the midportion of the T-colon formed adhesion and fistula (-). Distal gastrectomy, Roux-en-Y anastomosis, T-colon segmental resection and anastomosis were performed. Recovery was uneventful and the patient remained well at the follow-up. Histology of the resected specimen revealed chronic peptic ulcer with fibrosis and chronic inflammation. Three month after discharge, there was no ulcer, inflammation or passage disturbance at anastomosis site on endoscopic examination and the patient improved his symptoms. We planned to monitor the patient with endoscopy, annually.