Jejunocolic Fistula after Gastrectomy Leading to Intractable Vomiting and Diarrhea: A Case Report

We report a case of a jejunocolic fistula after gastrectomy leading to intractable vomiting, diarrhea, and malnutrition. A 55-year-old woman underwent distal gastrectomy with regional lymph node dissection for poorly differentiated adenocarcinoma of the stomach in May 1998. Intractable vomiting and diarrhea developed in January 1999, and persisted thereafter. Malnutrition became obvious with a progressive 6 kg weight loss. The patient was admitted to our hospital in June 1999.Plain abdominal X ray film showed mild dilation of the small intestine with air-fluid levels. A barium enema study revealed a fistulous tract between the small intestine and the transverse colon, the proximal portion of which was dilated. The jejunum and transverse colon were resected segmentally with en bloc excision of the fistulous tract. Pathological examination revealed poorly differentiated adenocarcinoma, located mainly in the subserosa of the colon next to the fistulous tract. Solitary peritoneal seeding from the gastric carcinoma was suspected. The patient recovered uneventfully from surgery, after which vomiting and diarrhea subsided immediately. Malnutrition was fully reversed. Some patients lose weight and report of diarrhea and other gastrointestinal symptoms after gastrectomy. Medical treatment is the therapeutic mainstay for such conditions. Our case, however, clearly demonstrates that surgically correctable factors may contribute to gastrointestinal symptoms after gastrectomy resistant to medical treatment. In such cases, surgical intervention should be adopted.