Management and Outcomes of Primary Coloduodenal Fistulas

Purpose Primary coloduodenal fistula (CDF) is a rare entity. We review our experience with the management and outcomes of CDF. Methods This is a retrospective review from 1975 to 2005 of patients with primary CDF. Patients were followed through clinic visits and mail correspondence with a mean (±SE) follow-up of 56 ± 14 months. Results Twenty-two patients were diagnosed at a mean age of 54 ± 3 years with primary CDF: benign ( n = 14) or malignant ( n = 8). Benign CDF were due to Crohn's disease ( n = 9) or peptic ulcer disease ( n = 5); malignant CDF was primarily due to colon cancer ( n = 7) plus 1 patient with lymphoma. Indications for operative intervention included intractable symptoms ( n = 15), gastrointestinal bleeding ( n = 14), and to rule out malignancy ( n = 8). Complete resection of malignant CDF with negative margins was achieved in half of patients after en bloc resection. Palliative bypass was performed in those patients with unresectable disease. Thirteen patients with benign CDF had resection of the fistula—2 of these patients required a duodenal bypass. There were no perioperative deaths, and the morbidity rate was 38%. Median survival for patients with malignant CDF was 20 months (range 1–150 months). Two patients with malignant CDF had >5-year survival. All patients with benign CDF who underwent fistula resection had resolution of fistula-related symptoms with one recurrence. Conclusion Benign CDF is amenable to operative therapy with resolution of symptoms and a low recurrence rate. Complete resection of malignant CDF can impart survival benefit.