An 84-year-old woman presented for repeat gastroscopy for follow-up of a benign gastric ulcer. She gave a 12-month history of worsening abdominal pain, nausea, non-feculent vomiting, diarrhoea and approximately 20 kilograms of weight loss. She denied any hematemesis, melena or fever. At the time of presentation, our patient was frail and emaciated. Regarding clinical examination, there were no abnormal abdominal findings. A chronic gastric ulcer on the greater curve of her stomach had been first diagnosed at the time of gastroscopy eighteen months earlier. Since then, she had undergone four further gastroscopies without any change.
Examination
On this occasion, gastroscopy revealed a deep ulcer of the greater curve of the stomach that appeared to penetrate the muscular layer and was highly suspicious of a fistula. The pathological report of the performed biopsy showed chronic inflammatory changes. An abdominal CT demonstrated a fistula between the stomach and transverse colon and excluded malignant disease. Contrast CT successfully diagnosed a fistula, excluded locally invasive disease and allowed pre-operative planning in a single step. A colonoscopy showed no evidence of primary colonic illness and failed to visualize the fistulous opening.
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