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Medical Treatment of Benign Gastrocolic Fistula

Erik P. Thyssen, MD; Leonard B. Weinstock, MD; Dennis M. Balfe, MD; and Burton A. Shatz, MD
[+] Article and Author Information

From Washington University School of Medicine, St. Louis, Missouri. Requests for Reprints: Erik P. Thyssen, MD, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8124, St. Louis, MO 63110. Acknowledgments: The authors thank Ms. Cynthia Fleisher for manuscript preparation.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1993;118(6):433-435. doi:10.7326/0003-4819-118-6-199303150-00007
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Benign gastrocolic fistula has been reported in patients taking anti-inflammatory drugs and has been traditionally managed with surgery. We describe two patients taking nonsteroidal anti-inflammatory medications who were found to have a benign gastrocolic fistula. Because of the relatively mild symptoms, a trial of medical therapy was initiated with documented successful closure of the fistula. These findings show that some patients with benign gastrocolic fistula can be managed medically.

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Figure 1.
A 52-year-old woman (Patient 1) with nausea, vomiting, and diarrhea.Top left.Top right.Top right.Bottom left.

An upper gastrointestinal barium study shows a large greater curvature ulceration (straight arrows). Barium from the stomach has filled the distal transverse colon (TC) through the penetrating ulcer (curved arrow). An upper gastrointestinal barium study shows a large greater curvature ulceration (straight arrows). Barium from the stomach has filled the distal transverse colon (TC) through the penetrating ulcer (curved arrow). An upper gastrointestinal barium study 6 weeks later shows deformity of the greater curvature (solid arrow) at the site of the previous ulcer; no fistula is shown. A barium enema performed at the same time shows a similar persistent deformity (empty arrow) along the superior haustral row of the distal transverse colon.

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