A 62-year old homeless man with poor nutrition was admitted to the Department of Dermatology of our University Hospital with leg edema and abdominal bloating. He had a past history of chronic diarrhea and leg tenderness for 9 months and once saw a doctor, but didn′t take regular medication or clinical check. After the leg edema got better, he was referred to the Division of Gastroenterology because of persisting abdominal bloating. CT scan showed a thickened part of the wall of transverse colon and ascites. The ascites was examined by aspiration and the cytology was class II. Finally with colonoscopy the thickened part was diagnosed as the fistula between stomach and transverse colon. The biopsy of this part revealed to be benign. In order to do the operation, he was moved to the Department of Surgery in January 2010 and soon the fistula was repaired.
Reports of gastrocolic fistula due to benign ulcer are quite rare. We diagnosed the fistula by using the dye while doing a colonoscopy. This is the first report of the use of this technique. This disease often presents with the trias of diarrhea, loss of weight, and stool-smelling vomit, and in this case we found 2 of them. We conclude that when seeing a patient with continuing diarrhea and weight loss in spite of good appetite, this condition should be investigated.
