A 75 year old woman presented to casualty with a one week history of upper abdominal pain, relative constipation, and faeculent vomiting. Examination revealed a soft, non-distended abdomen, with bowel sounds present and soft stool on rectal examination.
The clinical picture suggested subacute small bowel obstruction, but abdominal X ray showed no dilated bowel loops or air-fluid levels. Small bowel follow-through revealed a large fistula from the greater curve of the stomach to the transverse colon (Fig 1). No evidence of obstruction was seen. At endoscopy the stomach was found to contain faeces, and there was a wide gastro-colic fistula, related to an ulcer (Fig 2). Histology was consistent with a benign gastric ulcer, with no evidence of malignancy or IBD. The patient had taken long-term NSAIDs for arthritis. She underwent surgical closure of the fistula, and made an uneventful recovery.
We believe that gastro-colic fistula related to benign ulcer disease is an increasingly rare diagnosis, perhaps as a result of improvements in acid suppression and H pylori eradication therapy.
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