PMC9852707_01
Gastroduodenoscopy showed a fistula with a diameter of 15 mm at the junction of the first and second parts of the duodenum, as well as an ulcer with a diameter of 8 mm next to the fistula (the black arrow indicates the fistula, and the yellow arrow indicates the ulcer). Fecal residue can be observed through the opening of the fistula.
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F1
Gastroduodenoscopy revealed a fistula with a diameter of 15 mm at the junction of the first and second parts of the duodenum, as well as an ulcer with a diameter of 8 mm next to the fistula (Figure 1).
(A,B) Biopsy of the ulcer revealed chronic active inflammation of the mucosa and ulcer formation.
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F2
A biopsy of the ulcer revealed chronic active inflammation of the mucosa and ulcer formation (Figures 2A,B).
Colonoscopy confirmed the presence of the fistula and a giant ulcer can be seen in the hepatic flexure of the transverse colon (the black arrow indicates the fistula, and the yellow arrow indicates the ulcer).
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F3
Colonoscopy confirmed the presence of a fistula, and a giant ulcer was observed in the hepatic flexure of the transverse colon (Figure 3).
(A,B) Biopsy of the colonic ulcer showed chronic inflammation of the mucosa with ulcer formation.
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F4
A biopsy of the colonic ulcer showed chronic inflammation of the mucosa with ulcer formation (Figures 4A,B).
Computed tomography indicated no clear boundary between the descending duodenum and the transverse colon (the red arrow indicates the transverse colon, and the yellow arrow indicates the descending duodenum).
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F5
Computed tomography indicated no clear boundary between the descending duodenum and transverse colon (Figure 5).
Upper gastrointestinal study revealed rapid transit of the contrast agent into the colon and confirmed the presence of a fistula (the white arrow indicates the fistula). C, colon; D, duodenum; S, stomach.
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F6
An upper gastrointestinal study revealed rapid transit of the contrast agent into the colon and confirmed the presence of a fistula (Figure 6).
(A) The dotted lines and red regions indicate the resected the part of stomach, duodenum, and colon, including the fistula. (B) The Roux-en-Y gastric bypass. (C) The end-to-end intestinal anastomosis.
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F7
Accordingly, the patient underwent resection of the segmental duodenum, distal stomach, and partial transverse colon (Figure 7A). Roux-en-Y gastric bypass and end-to-end intestinal anastomosis were chosen to reconstruct the stomach and colon, respectively (Figure 7B,C).
(A,B) Pathologic examination showed chronic active inflammatory mucosa of the gastrointestinal tract with erosion and ulcer formation, stromal fibrosis, focal neutrophil, lymphocyte, and plasma cell infiltration. There was no evidence of tumor infiltration in the resected specimen.
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F8
There was no evidence of tumor infiltration in the resected specimens (Figures 8A,B).
Postoperative imaging findings after surgical treatment of the fistula. Upper gastrointestinal series showed the contrast media entered the gastric stump and passed smoothly through the anastomosis into the jejunum with no obvious fistula (the white arrow indicates the gastrointestinal anastomosis). GS, gastric stump; J, jejunum.
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F9
An oral contrast study performed 3 weeks later revealed that the contrast media entered the gastric stump and passed smoothly through the anastomosis and into the jejunum with no obvious fistula (Figure 9).