ABSTRACT

Gastrojejunocolic fistula is a rare but significant complication seen in the later phase in patients who had antrectomy and Bilroth II gastroenterostomy because of peptic ulcer. The failure to perform complete antral resection or adequate vagotomy results in ulcer recurrence. A clinical picture accompanied by abdominal pain, fecaloid vomiting, diarrhea, and weight loss manifests itself as a result of the penetration of the marginal ulcer into the transverse colon. A 59-year-old male patient, who had undergone surgery because of peptic ulcer 37 years before, was referred to our clinic upon the detection of gastrojejunocolic fistula while he was being evaluated for diarrhea and weight loss that had been going on for the last 6 months. The patient, who had malnutrition, received total parenteral nutrition support followed by en bloc resection, posterior vagotomy, Roux-en-Y gastrojejunostomy, and primary colon anastomosis in a single session. The patient underwent relaparotomy because of intra-abdominal bleeding in the early post-operative phase and he was seen to have bleeding originating from the mesocolon which stopped spontaneously. The patient died of transfusion related acute lung injury related to erythrocyte suspension administered because of tachycardia and hypotension that developed secondarily to anemia. While chronic diarrhea and weight loss can be the dominant symptoms in cases with previous history of ulcer surgery, delays in diagnosis can be prevented by taking the possibility of gastrojejunocolic fistula development into consideration as well.