Management of gastrocolic fistula

The authors present 13 patients with gastrocolic, gastrojejunocolic, or duodenocolic fistula, the majority of which were complications of peptic ulcer disease or its treatment. In contrast to previous reports, these patients were not severely anemic, dehydrated, or malnourished at time of presentation. Pain, fecal emesis, and diarrhea were the most common presenting symptoms. Half of the patients waited more than two weeks before seeking treatment. Barium enema and upper gastrointestinal series were equally useful in making the diagnosis in this study. When the patient was adequately prepared, one-stage operations could be performed safely in most situations. Operation may not be necessary or advisable in patients with metastatic malignant disease with minimal symptoms relating to fistulization.