Presentation
Initially presented following a high speed motor vehicle accident and was subsequently diagnosed with a left diaphragmatic rupture which was repaired with surgical management.
Patient Data
The gastrocolic fistula is demonstrated with communication between the greater curvature of the gastric body and the splenic flexure. Oral contrast is seen throughout both the small and large bowel. Persistent inflammatory changes through the left upper quadrant without extraluminal spillage.
Pelvic external fixation device into the ilium bilaterally. Transverse screw fixation of bilateral sacroiliac joints with screw fixation of the right sacroiliac joint. Right inferior and superior pubic ramus fractures which extend into the pubic symphysis. Healing fractures of the bilateral transverse processes of the lumbar spine and bilateral ribs.
Persistent small bilateral pleural effusions associated with basal atelectasis.
Case Discussion
The gastrocolic fistula was confirmed on endoscopy and was managed with a left hemicolectomy, distal pancreatectomy and gastrectomy.
Intraoperative findings: dense adhesions, gastro-colic fistula involving the gastric fundus and splenic flexure of the colon, and a pancreatic tail densely adherent to the fistula complex.
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