A gastrocolic fistula as a complication of peptic ulcer

Abstract

Aim. Improving the diagnosis and treatment of multiple complications of peptic ulcer. Materials and Methods. Retrospective analysis of clinical signs, results of laboratory, instrumental examinations and surgical treatment of multiple peptic ulcer complications in a 54-year-old patient H., who was treated at the Department of Surgery №2 of Lviv Regional Clinical Hospital. Results and Discussion. In a 54-year-old patient with 20 years history of peptic ulcer, a combined complication developed: decompensated pyloric stenosis, penetration of gastric ulcers to the transverse colon with formation of a gastro-colic fistula, which was confirmed only at contrast CT of abdominal cavity. These complications led to severe disturbance of fluid-electrolyte and acid-base balance. After the correction of fluid-electrolyte and acid-base balance, a one-stage operation was performed - the Billroth II resection of the stomach with gastro-enterostomy on a short loop, and transverse colon resection with end-to-end anastomosis. Conclusions. Verification of diagnosis in patients with peptic ulcers with multiple complications needs advanced diagnostic procedures. Combination of gastric outlet obstruction and penetration of peptic ulcer to the transverse colon with fistula formation lead to significant disturbances of water-electrolyte and acid-base balance. Simultaneous operation (Billroth II gastric resection and resection of the transverse colon with end-to-end anastomosis) is possible after thorough correction of fluid-electrolyte and acid-base balance.

Keywords

• gastric outlet obstruction, penetration, gastro-colic fistula, surgical treatment