Spontaneous gastrocutaneous fistula presenting as a long-standing abdominal wall nodule: a case report

Spontaneous gastrocutaneous fistula (SGCF) is an extremely uncommon clinical condition. In modern practice, most gastro-abdominal fistulas are acquired, typically arising from iatrogenic causes, major abdominal trauma, or direct invasion by advanced gastrointestinal malignancies. SGCF resulting exclusively from benign chronic gastric ulcer penetration is rarely reported and is generally regarded as a historical curiosity.

An 81-year-old man presented with persistent enteric-like drainage after traumatic disruption of a subcutaneous abdominal nodule that had been stable for approximately three decades. Comprehensive imaging and endoscopic investigations confirmed the presence of an SGCF originating from a benign gastric ulcer. Laparoscopic exploration demonstrated dense, localized fibroinflammatory adhesions anchoring the stomach to the anterior abdominal wall. Definitive management consisted of en bloc excision of the fistulous tract combined with a laparoscopically assisted subtotal gastrectomy, which was completed successfully.

Although rare, benign penetrating gastric ulcers may give rise to chronic fistulous tracts involving the abdominal wall. In the present case, the imaging, operative, and histopathological findings supported a chronic localized fistulizing process in which the formation of dense adhesions may have limited free perforation. After careful exclusion of malignancy, mature fibrotic fistulas of this type generally require definitive en bloc surgical resection.