1983 Volume 25 Issue 8 Pages 1268-1273_1
A patient with gastro-jejuno-colic fistula developing 11 years after operation for duodenal ulcer was reported. A 53-year-old man was admitted to Gifu Univ. Hosp. because of recurrent diarrhea, emaciation, abdominal pain, and fecal smelling belch. Laboratory data on admission showed hypoproteinemia with hypoalbuminemia. A basal plasma gastrin level was less than 10 pg/ml, and plasma secretin level was high, 445 pg/ml. The peak acidity of gastric juice responded to tetra-gastrin was 82 mEq/l. Barium enema demonstrated a free communication from the mid-transverse colon to the remnant stomach. Two open ulcers were revealed as well as fistula to the colon near the portion of previous gastro-jejunostmyby the endoscopic examination. In the previous operation by Billroth II method, the only one-third of stomach had been resected. The transverse colon lay anterior to the gastrojejunostomy, and they adhered each other. The fistula was found there. Although the f istulectomy was performed on this admission, post operative ulcer was recurrent four months later. No histological evidence of malignancy was noted. In the re-examination of gastrin test, the peak acidity was only 20 mEq/l. So in this case, large remnant stomach and/or some other unknown factors might resulted in incidence of stomal ulceration and the gastro-jejuno-colic fistula.
