Malignant duodenocolic fistula. Various therapeutic surgical modalities

Malignant duodenocolic fistulas are the most rare and evolutive complication of colonic cancer due to their rapid nutritional disturbances and difficult surgical management. This case report details a 23-year-old female who presented with diarrhea, anorexia, weight loss, anemia and abdominal pain. A series of examinations showed a transverse colon carcinoma with a malignant duodenocolic fistula and direct infiltration of the right lobe of the liver. The patient underwent extended right hemicolectomy with wide local excision of the duodenum and segmental hepatic resection. Postoperative recovery was uneventful. The analysis of other similar cases from the literature treated with this procedure or less frequently, with right hemicolectomy and pancreaticoduodenectomy, allows us to discuss the indications and results of radical surgery. Whenever feasible, resection offers the best treatment as lesser techniques such as bypass and exclusion result only in minimal palliation. The benefit of exploration should almost always be offered, even in such secondary fistulas, as a better quality of life and long term survival are realistic goals and prognostically justifiable.