Abstract

Introduction: Since the beginning of the 1990s, surgical procedures for peptic ulcer disease have been very rare as a result of administering medical treatments such as proton pump inhibitors and anti-Helicobacter Pylori therapy. The post- surgical complications may be noticed presently, i.e. 10, 20 or more years after the initial surgical treatment. Gastrojejunocolic fistula (GJCF) is one of the complications. The symptoms include chronic diarrhea and weight loss. Ingested food passes through the fistula, bypassing all of the small intestine and a part of the colon. Contrast examination is the most sensitive diagnostic tool. The treatment is surgical, preceded by suitable protein-electrolyte preparation. Unlike previous years, surgical approach is now a single-stage procedure.

Case report: A 60- year old man was admitted to hospital, complaining of progressive weight loss, chronic diarrhoea, and feculent breath. The clinical examination took a few months, including rare disease diagnostics (APUD tumours). Endoscopic examinations were performed repeatedly, but none showed a minor fistula, as it had been at the beginning. The diagnosis was made by contrast examination of the gastro duodenum. After electrolyte imbalance and nutritional deficiencies were resuscitated, a re-resection of the stomach, anastomotic ulcer, proximal jejunum and transverse colon was performed in a single-stage procedure. The reconstruction of the gastro-jejunum was performed by Roux- en-Y technique, and colocolic anastomosis was performed during a single-stage procedure. The patient was discharged from the hospital on the 11th postoperative day, but he continued treatment for R-y stasis syndrome. The weight gain after 6 months was 15 kg, and the patient did not report diarrhea or feculent breath.

Conclusion: The modern diagnostic methods might have unjustly challenged the importance of contrast examination of the digestive tract. In our case, contrast radiography was used to make a diagnosis. Chronic diarrhea symptom is present in infectious enterocolitis, while Crohn’s disease or a malignancy may also be suspected. In case when more frequent diseases are excluded, the mentioned fistula should be considered. Nowadays, GJCF surgery is performed as a single-stage procedure after providing adequate protein-electrolyte preparation.

Keywords: Dermatofibrosarcoma protuberans, Mohs surgery, Vulva