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Benign Duodeno-Colic Fistula

1940; Radiological Society of North America; Volume: 34; Issue: 3 Linguagem: Inglês

10.1148/34.3.343

1527-1315

Clarence N. McPeak,

Esophageal and GI Pathology

DUODENO-COLIC fistula is a rare finding and of the few cases reported in the literature only two have been described as being due to benign lesions; it is an abstract of these two cases which will be given in this paper. The other cases were all due to a carcinoma of the transverse colon perforating into the duodenum. Other cases may have been reported in connection with other lesions of the gastro-intestinal tract, but I have been able to find only two cases reported under the heading of “duodeno-colic fistula” from 1885 up to the present time. The etiology of benign duodeno-colic fistula is usually a perforation of a duodenal ulcer into the transverse colon with a resulting fistula between the two. Other benign lesions may cause a fistula between the duodenum and colon, but none could be found reported in the literature. The absence of a typical history of duodenal ulcer does not exclude this as the cause, for we are all familiar with cases of duodenal ulcer in which the only sign or symptom of the ulcer may be a sudden hemorrhage, with subsequent roentgenography demonstrating the presence of an ulcer though the patient still presents no real symptom of the ulcer except for the hemorrhage. The fistula may involve any part of the duodenum because of the close relationship between the duodenum and the transverse colon. Ulcers of the second and third parts of the duodenum are probably more common than is generally realized. Hauser (1), using the combined statistics of five authors on the location of perforated duodenal ulcers, lists 274 as being located in the first part, 12 in the second part, and five in the third part. This indicates that almost 6 per cent of perforated duodenal ulcers are located in the second or third part of the duodenum. These figures are probably high for a general average, as there may be a greater tendency for ulcers of the second and third parts of the duodenum to perforate than for ulcers of the first part. These figures, however, do indicate that ulcers of the second and third parts of the duodenum are more common than we realize. Accurate statistics on the frequency of ulcers beyond the first part of the duodenum are not available, because ulcers here are more difficult to detect roentgenologically than in the first part and they are usually not operated upon unless they perforate. The patient with a duodeno-colic fistula mayor may not give a history of a sudden abdominal pain. A persistent diarrhea with rapid loss of weight, in spite of a voracious appetite, is quite typical of a duodeno-colic fistula. This history is common for any fistula between the colon and the upper gastro-intestinal tract and is not specific for a duodeno-colic fistula. Blondeau and his co-workers (2) reported a case of a 55-year-old man who came to them for an incorrigible diarrhea, the yellowish liquid containing undigested alimentary débris.