Gastrocolic fistula complicating benign unoperated gastric ulcer. Report of four cases and review of the literature

Of 957 patients undergoing operation for benign gastric ulcer and its complications from 1965 through June 1975, 90 had perforated ulcers. Among these were four patients in whom a gastrocolic fistula had formed. Although two of the four patients had symptoms due to peptic ulcer dating back 12 and 68 months, symptoms of a gastrocolic fistula were the initial presentation of ulcer disease in the other two. All four patients had watery diarrhea and weight loss, and barium enema examination was diagnostic in each case. The perforating ulcers were located in the distal stomach on the greater curvature in all four patients. Although enterostasis was not present in these cases, regurgitation of colonic contents probably results in bacterial overgrowth in the small intestine, causing structural and functional damage to the mucosal cells by bacterial products, manifested clinically by diarrhea in 75% of the patients. Surgery should be advised in all cases after adequate preparation of the patient; bowel preparation with cathartics, enemas, and oral antibiotics is mandatory. The preferred operation is one-stage enbloc hemigastrectomy and resection of the involved segment of colon along with the fistulous tract. The present series brings to 43 the total number of cases of gastrocolic fistulas complicating benign, previously unoperated gastric or duodenal ulcers. There is an appreciable mortality associated with this condition - 7 of these 43 patients (16%) died as a direct consequence of their fistula.