Malignant Gastrocolic Fistula as a Late Complication of Radiation Therapy

Excerpt

Malignant gastrocolic fistula is a rare mode of presentation of gastric or colonic carcinoma [1‐3]. A benign aetiology is more common, including peptic ulcer disease, particularly benign gastric ulcers which may relate to non-steroidal anti-inflammatory use. Other benign causes include inflammatory bowel disease, post-PEG insertion, post-gastroenterostomy, pancreatitis, abdominal tuberculosis, trauma, perforated diverticular disease and infections including CMV, histoplasmosis, actinomycosis, amoebiasis, echinococcosis and lymphogranuloma venereum [2, 4‐7]. A malignant gastrocolic fistula is most commonly found between the greater curvature of the stomach and the distal half of the transverse colon [8]. They are usually seen in the setting of large infiltrative tumours with a surrounding inflammatory reaction, and lymph node involvement is uncommon [8]. The colon rather than the stomach is the more usual site of origin. In a review of 1,500 cases of stomach cancer and 3,200 cases of colon cancer at the Lahey Clinic, 11 cases of gastrocolic fistula were reported, with 10 being of colonic origin [9]. …