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From question on page 468

Figure 1 reveals a chronic, giant, high lesser curve ulcer with clots, and a rosette-like mucosal island. This gastrocolic fistula “stoma” was intubated at initial gastroscopy (fig 2A, 2B). Biopsy excluded malignancy. Figure 1B shows the ulcer but the fistula is incompletely visualised.

Figure 2

 Intubated of the gastrocolic fistula “stoma” at initial gastroscopy.

The patient was given acid suppression and nasojejunal feeding, prior to limited resectional surgery. Histology revealed no malignancy. He was discharged on day 7 and remains well three months later.

Gastrocolic fistula is an unusual complication of peptic ulceration. It must be suspected, especially in young females on ulcerogenic agents, with halitosis, feculent vomiting, postprandial diarrhoea, with or without dyspepsia or weight loss. The ulcer is usually situated on the greater curve. We believe postprandial diarrhoea was absent in this case because of its location on the lesser curve.

Contrast enema demonstrates the fistula in nearly all cases and endoscopy can be reserved for biopsy to exclude malignancy.

To our knowledge, a fistula tract permitting gastroscopic intubation of the colon has not been described previously or documented by endoscopic images.

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