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Gut. 2007 June; 56(6): 829.
PMCID: PMC1954866

EDITOR'S QUIZ: GI SNAPSHOT

Answer

From the question on page 820

The endoscopic image revealed a volcano‐like mass lesion with hyperaemia, and swollen mucosa over the lower part of the body of the stomach, with some stool‐like fluid observed (fig 1). CT scan disclosed a fistula between the stomach and the transverse colon (fig 2). A clinical diagnosis of gastrocolic fistula due to colonic cancer with liver metastasis was made. The diagnosis was confirmed at surgery for mechanical ileus after 2 weeks. Pathological examination of the resected tumour revealed adenocarcinoma arising in the colonic mucosa with infiltration into the gastric submucosa.

Advanced neoplasm is the most common aetiology of gastrocolic fistula. Other causes, including benign gastric ulcer, Crohn's disease, cytomegalovirus‐related gastritis and percutaneous endoscopic gastrostomy, have been reported in the literature. Common symptoms include diarrhoea, weight loss, feculent vomiting, epigastralgia and fatigue. The diagnosis is usually made on barium contrast radiography, endoscopy or CT. For a benign aetiology, treatment usually includes parenteral nutrition and intravenous H2‐receptor antagonists or proton pump inhibitors. Radical en‐bloc surgery with adjuvant chemotherapy is usually required to provide long‐term survival for patients with malignancy.


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