Gastrojejunocolic fistula after gastroenterostomy with Billroth II reconstruction for duodenal ulcer: Report of a case

摘要

Gastrojejunocolic fistula is a late, rare and severe complication of gastroenterostomy with Billroth II reconstruction for peptic ulcer and is associated with inadequate gastric resection and incomplete vagotomy. The fistula is thought to be due to perforation of a marginal ulcer into the transverse colon. In the past, attempted primary repair had high mortality and staged operations were normally performed. We herein report the case of a 60 year-old man with gastrojejunocolic fistula who was admitted to our hospital with a symptom triad of faecal vomiting/breath, chronic diarrhea and weight loss. His history included a distal gastric resection and Billroth II reconstruction for a duodenal ulcer 15 years previously. The laboratory data on admission revealed hypoproteinemia and hypoalbuminemia. Both barium-enema and colonoscopy examination showed the existence of the gastrojejunocolic fistula. After improving his state of malnutrition, a one-stage repair was performed. The postoperative course was uneventful and the patient was discharged on the 22th postoperative day. In this case, improved nutritional support allowed successful one-stage surgical repair to be performed.