A Case of Jejunal Transverse Colon Fistula due to Anastomic Ulcer after Pylorus-preserving Pancreaticoduodenectomy

Abstract

A 63-year-old man presented to our department because of diarrhea with tarry stool and halitosis. He had undergone pylorus-preserving pancreaticoduodenectomy for a pancreatic neuroendocrine tumor 11 years earlier. Esophagogastroduodenoscopy (EGD) conducted for tarry stool, of which he was aware 6 months before, showed an ulcer at the duodenal-jejunal anastomosis, and he had been administered an oral proton pump inhibitor. EGD taken in our department showed a fistula with the transverse colon at the same site. A Jejunal transverse colon fistula due to anastomotic ulcer was diagnosed and surgery was performed. A duodenal-jejunal anastomosis was performed by the anterior colonic route, which caused a mass due to inflammation. Gastrectomy was performed including the anastomosis forming the fistula and the transverse colon. Histologically, an ulcer was found in the jejunum near the anastomosis, but no neoplastic lesion was found. The postoperative course was favorable, and the patient was discharged on the 15th postoperative day. No recurrence of ulcerative lesions has been observed as of 12 months after the surgery. Gastrointestinal fistula caused by anastomotic ulcer after pancreaticoduodenectomy is rare.