Treatment and Outcome of Patients in Reported Series of Gastrocolic Fistula in Crohn’s Disease
| Series | Age, yr | Sex | Treatment | Outcome |
|---|---|---|---|---|
| Bargen et al, 1937 (10) | 22 | M | Medical | No improvement with medical therapy, patient ultimately died |
| Ormandy and Bargen, 1939 (11) | 31 | M | Medical | Died 2 mo after admission; gastrocolic fistula diagnosed at autopsy |
| Altcheck and Summer, 1957 (12) | 30 | M | Total colectomy and ileostomy; repair of fistula | Uncomplicated recovery |
| Theony et al, 1960 (14) | NS | NS | 2-stage procedure: stage 1— bypass ileosigmoidostomy, stage 2 — resection of bypassed bowel and wedge resection of fistula | NS |
| Leitchling and Garlock, 1962 (15) | 50 | F | 2-stage procedure: stage 1— bypass ileosigmoidostomy, stage 2 — resection of bypassed bowel and wedge resection of fistula | Uncomplicated recovery, infrequent abdominal pain |
| Amlicke and Ponka, 1964 (4) | 49 | F | Partial colectomy | Died 3 yr postop of hepatitis |
| Cohen, 1967 (16) | 22 | M | Gastrojejunostomy and vagotomy, transverse colostomy | Uncomplicated recovery |
| Haggitt and Meissner, 1973 (17) | NS | NS | Partial gastrectomy and duodenectomy | Died 7 mo postop of acute gastrointestinal hemorrhage |
| Cody et al, 1975 (3) | 29 | F | Ileocolostomy and repair of fistula | Persistent primary disease |
| Wilk and Moqtaderi, 1976 (8) | 60 | F | 2-stage procedure: stage 1 — subtotal colectomy and ileostomy, sigmoid mucous fistula, wedge resection of fistula, stage 2 — ileosigmoidostomy | Uncomplicated recovery |
| Metzgher and Ranganath, 1976 (18) | 62 | M | En bloc resection of terminal ileum, right and transverse colon and antrum; truncal vagotomy | Uncomplicated recovery |
| Laufer et al, 1977 (5) | 31 | F | Total colectomy and ileostomy | Postop course complicated by recurrent abscesses; patient ultimately died of extensive Crohn’s disease and malnutrition |
| Kokal et al, 1978 (19) | 38 | M | Right and transverse colectomy with descending ileocolostomy; partial gastrectomy with Billroth I gasteroenterostomy | Brief episodes of diarrhea responsive to medication, otherwise uncomplicated recovery |
| 34 | F | Total proctocolectomy and ileostomy; partial gastrectomy and Billroth II gastroenterostomy | Uncomplicated recovery | |
| Zapolanski and Jagelman, 1980 (20) | 33 | M | 2-stage procedure: stage 1 — loop ileostomy, stage 2 — proctocolectomy and fistula repair | Uncomplicated recovery |
| Lawhon, 1980 (21) | 19 | F | Total colectomy and ileoproctostomy; fistula repair | NS |
| McDaniel et al, 1982 (22) | 26 | F | Total colectomy and ileostomy and Hartmann procedure; fistula repair | NS |
| Broe et al, 1982 (23) | NS | NS | NS | NS |
| Scully et al, 1983 (24) | 39 | M | En bloc resection of distal half of stomach and ascending and right transverse colon | Uncomplicated recovery |
| Jacobson et al, 1985 (25) | 26 | F | Right and transverse colectomy; wedge resection of fistula | Uncomplicated recovery; no recurrence for 6 yr |
| 39 | M | Hemigastrectomy and vagotomy, Billroth II gastroenterostomy; right and transverse colectomy | Primary healing; no recurrence for 3 yr | |
| Logio et al, 1987 (26) | 42 | F | Subtotal colectomy; circumferential sleeve resection of stomach and pyloroplasty | Uncomplicated recovery |
| Greenstein et al, 1989 (27) | 21 | M | Initial surgery — gastroenterostomy; re-exploration — subtotal colectomy and ileostomy, mucous fistula and repair of fistula | Initial surgery complicated by recurrent gastrocolic fistula; uncomplicated recovery after re-exploration |
| 29 | F | Total colectomy and ileostomy; wedge resection of fistula | Episode of ileostomy hemorrhage, otherwise uncomplicated recovery | |
| 25 | M | Subtotal colectomy and ileosigmoidostomy; sleeve resection of greater curvature of stomach | Uncomplicated recovery | |
| 31 | M | Ileostomy and 6-MP postop | Uncomplicated recovery | |
| 49 | F | 6-MP | Initially improved but relapsed after cessation of therapy; restarted on 6-MP and asymptomatic for 2.5 yr on long-term 6-MP maintenance therapy | |
| 21 | M | 6-MP | Remission of symptoms and closure of fistula within 3 mo, but fistula reopened and symptoms recurred after cessation of therapy; restarted on 6-MP for 4 yr and remained asymptomatic for 8 yr | |
| 60 | F | Subtotal colectomy, mucous fistula; gastroenterostomy and wedge resection of fistula | Uncomplicated recovery | |
| Flueckiger et al, 1990 (28) | 29 | M | Left hemocolectomy and transverse colosigmoidostomy and fistula repair | Uncomplicated recovery |
| Pichney et al, 1992 (29) | 29 | F | Ileocolonic resection and fistula repair | NS |
| Gidvani and Mizell, 1997 (1) | 13 | F | Partial colectomy and fistula repair | Re-exploration 3 wk postop because of recurrent symptoms — negative findings; uncomplicated recovery thereafter |
NS = not specified, 6-MP = 6-mercaptopurine.