[Colopleural fistula complicating laparotomy for perforated gastric ulcer]

Colopleural fistula is a very rare clinical problem which was described barely in a few articles. Common causes of this kind of fistula are strangulated diaphragm hernias and neoplasms of the splenic flexure of the colon. We report a case of 58 years old male with colopleural fistula. Symptoms of left sided pyo and pneumothorax appeared two weeks after laparotomy for perforated peptic gastric ulcer. Chest tube was inserted and antibiotics was used. The pyothorax was evacuated almost entirely. Left sided recurrent purulent thoracic wall fistulas complicated the latter two and a half year course. Finnaly the reccurence of left sided pyothorax leaded to surgical treatment. During thoracotomy decortication and resection of cirrhotic lover lobe of the left lung was performed. In the postoperative course faecal fluid appeared in the left pleural cavity. The patient was transfer to The Surgical Department where fistula between colon and pleural cavity was confirmed by colonoscopy. During laparotomy fistula between splenic flexure of the colon penetrating through diaphragm was confirmed and excised. The patient was cured. On the basis of reviewed literature we discuss possible pathological mechanisms of creating colopleural fistula, diagnostic workup and treatment. We conclude that colonoscopic examination may be helpful in diagnosis and localization of fistula site when radiological examination fails. Colopleural fistula course may lasts with few symptoms for years.