A CASE OF DUODENOCOLIC FISTULA DUE TO COLON CANCER

A 62-year-old man was found by upper gastrointestinography to have a fistula between the hepatic flexure of the colon and the second portion of the duodenum due to colon cancer in the hepatic flexure. He complained of general fatigue, abdominal distension and vomiting. Because his general condition had deteriorated owing to ileus caused by obstruction of the colon, we performed a loop colostomy in the caecum. After improvement of his general condition, right hemicolectomy, resection of the anterior wall of the duodenum, partial resection of the pancreas and gastrojejunostomy were performed. His condition was diagnosed as mucinous carcinoma of the colon histopathologically. The patient is still living six months after the radical operation in spite of a recurrence in the abdominal wall. Duodenocolic fistula caused by colon cancer is rare. Only 23 cases have been reported in the past 28 years in Japan. Prognosis for these patients with a fistula was not necessarily worse than that for patients without a fistula. However the prognosis for patients with mucinous carcinoma of the colon was not good because of frequent patterns of recurrence such as local recurrence, peritoneal dissemination, liver metastasis. Therefore sufficient follow-up of these cases is required.