A gastrocolic fistula (plural: fistulas/fistulae), also known as cologastric fistula, is a rare form of gut fistulisation between the stomach and the colon.
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Terminology
Gastrocolic fistula, is much more common in the literature than its synonym cologastric fistula, which is in line with the convention that the more proximal structure in the gut becomes the prefix, and the more distal part the suffix, regardless from which structure the pathological process started.
Epidemiology
Gastrocolic fistulas are rare, most commonly seen in the context of advanced invasive malignancy. These particular fistulas seem to be more common in women, especially 50-60 years old 4.
Clinical presentation
A gastrocolic fistula should always be suspected in anyone with persistent/frequent vomiting of faeces who lacks an acute abdomen and/or other signs of bowel obstruction; as the commonest cause of faeculent vomiting is high grade bowel obstruction 4.
The classic triad described for gastrocolic fistula is 2,4:
In truth, a broader spectrum of signs and symptoms may be seen including 4:
Pathology
A gastrocolic fistula is thought to arise from a lengthy inflammatory reaction in which epithelial cells from the stomach/colon move into the deeper strata of the gut wall resulting in a focus of tissue damage. Consequently, a communication forms with a proximate organ, in this case either the stomach or colon 4.
Aetiology
Commonest cause of a gastrocolic fistula are malignancies, perhaps unsurprisingly particularly colonic and gastric primaries.
Other causes
- other malignancies, e.g. hepatic, pancreatic, biliary 4
- benign inflammatory disease, including:
- peptic ulcer disease 2
- colonic diverticular disease
-
pancreatitis
- especially recurrent
- pancreatic abscess
-
iatrogenic
- gastric surgery 1
Location
A gastrocolic fistula extends between the large bowel, usually distal, and the stomach, the greater curvature of the body, is the commonest gastric segment affected 4.
Radiographic features
Unfortunately, both gastroscopy and colonoscopy often fail to identify the fistulous opening. Biopsies are also often inconclusive. Imaging is often the only way to clinch the diagnosis of gastrocolic fistula 4.
CT with oral contrast is the commonest technique to confirm the presence of a gastrocolic fistula. Occasionally more traditional fluoroscopic methods, e.g. barium meal, may make the diagnosis.
History and etymology
The first case of gastrocolic fistula reportedly due to malignancy was reported by Albrecht von Haller in 1775 5.
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