Chronic diarrhoea in an elderly woman: a challenging maze

A colonoscopy, performed 7 months before hospital admission, revealed erythema of the distal colon and rectum, with biopsies showing a subtle chronic inflammatory infiltrate, and a colo-colonic anastomosis 45 cm from the anal verge. A barium study revealed passage of contrast from the gastric body to the descendent colon (figure 2), in relation with a gastrocolic fistula (GCF). A GCF is an abnormal communication between the stomach and the colon, most commonly due to neoplastic invasion, but also iatrogenic, following surgery or gastrostomy tube migration.1 The incidence of iatrogenic GCF is unknown, with few case reports predominantly related to bariatric surgery.2 The best diagnostic tool is a barium study.3 Endoscopy is mandatory to exclude malignancy, despite easily missing the fistula.4 The best treatment approach is surgery, with less invasive treatments, such as an over-the-scope-clip, emerging for selected cases.1 3 Ethics statements Patient consent for publication Consent obtained directly from patient(s).