Malignant sigmoidoduodenal fistula
I M Shapey1, K Mahmood1, M H Solkar1
1Tameside General Hospital, Fountain Street, Ashton-under-Lyne OL6 9RW, United Kingdom.
International Journal of Surgery Case Reports
|December 3, 2014
Summary
A rare sigmoido-duodenal fistula, a complication of colon cancer, presented unusually in an elderly patient. Management requires careful consideration of patient factors, often favoring non-operative approaches.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Colorectal Surgery
Background:
- Duodenocolic fistula is a rare complication of malignant colonic disease.
- Sigmoid colon involvement is particularly uncommon.
Purpose of the Study:
- To discuss the unusual clinical presentation of a sigmoido-duodenal fistula.
- To outline the investigation and management strategies for duodenocolic fistulas.
Main Methods:
- Case presentation of a 91-year-old female with emergency surgical admission.
- Diagnostic workup included Computed Tomography (CT), colonoscopy with histology, and barium enema.
Main Results:
- CT revealed an ovarian cyst near the sigmoid colon and duodenum.
- Colonoscopy confirmed adenocarcinoma with a fistulating tract from the sigmoid colon to the duodenum.
- Barium enema demonstrated a classic apple core lesion and the fistulating tract.
Conclusions:
- Sigmoido-duodenal fistulae are complex manifestations of gastrointestinal pathologies.
- Management decisions should incorporate patient wishes, comorbidities, and predicted outcomes.
- Non-operative management is often preferred, but surgical resection may be beneficial in select cases.
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