Dis. Col. & Rect. 224 TOROSIAN, ET AL. ~,p~il 1982

T h e p a t i e n t d e s c r i b e d h e r e h a d p r e v i o u s l y u n d e r - g o n e r i g h t h e m i c o l e c t o m y a n d to ta l g a s t r e c t o m y wi th

e s o p h a g o j e j u n o s t o m y fo r two p r i o r ma l i gnanc i e s . A t h i r d m a l i g n a n c y o r i g i n a t e d in t he t r a n s v e r s e co lon wi th s u b s e q u e n t f i s tu l i za t ion in to t he a f f e r e n t l imb o f t he j e j u n u m . T h e m a l i g n a n c y , f i s tu la t rac t , a n d in- vo lved j e j u n u m a n d c o l o n w e r e r e s e c t e d en bloc. A

R o u x - e n - Y j e j u n o j e j u n o s t o m y , p r o x i m a l e n d colos- tomy, a n d d i s t a l m u c o u s f i s tu la we re c r e a t e d .

A n en bloc r e s e c t i o n o f this m a g n i t u d e is t h e on ly t h e r a p e u t i c a p p r o a c h t ha t has r e s u l t e d in l o n g - t e r m surv iva l f r o m m a l i g n a n t c o l o e n t e r i c f is tula. 9'~4 I f t he p a t i e n t h a d b e e n at b e t t e r o p e r a t i v e risk, t he a u t h o r s w o u l d have p e r f o r m e d sub to t a l c o l e c t o m y fo r th is m e t a c h r o n o u s co lon ic c ance r . T h i s was d e e m e d i n a d - visable d u e to t h e p a t i e n t ' s age , m a l n u t r i t i o n , a n d p n e u m o n i t i s .

References

1. Lefebvre BM, Gardner CM. Malignant duodenocolic fistula. Can J Surg 1959;3:86-90.

2. WelchJP, Warshaw AL. Malignant duodenocolic fistulas. AmJ Surg 1977;133:658-61.

3. Smith TR, Goldin RR. Radiographic clinical sequelae of the duodenocolic anatomic relationship: two cases of Crohn's disease with fistulization to the duodenum. Dis Colon Rec- tum 1977;20:257-62.

4. Brindle MJ, Kane JF. Benign duodenocolic fistula. Br J Surg 1966;53:749-53.

5. Abcarian H, Udezue N. Coloenteric fistulas_ Dis Colon Rectum 1978;21:281-6.

6. Webster MW, Carely LC. Fistulae of the intestinal tract. Curr Probl Surg 1976 June 13:1-78.

7. Akwari OE, Edis AJ, Wollaeger EE. Gastrocolic fistula com- plicating benign unoperated gastric ulcer: report of four cases and review of the l i terature. Mayo Clin Proc 1976;51:223-30.

8. Hofmann AF. The syndrome of ileal disease and the broken enterohepatic circulation: cholerhetic enteropathy. Gas- troenterology 1967;52:752-7.

9. Vieta JO, Blanco R, Valentini GR. Malignant duodenocolic fistula: report of two cases, each with one or more other synchronous gastrointestinal cancers. Dis Colon Rectum 1976;19:542-52.

10. Dudrick SJ, Wilmore DW, Steiger E, Mackie JA, Fitts WT Jr. Spontaneous closure of traumatic pancreatoduodenal fis- tulas with total intravenous nutrition. J Trauma 1970;10:542-53.

11. MacFadyen BV Jr, Dudrick SJ, Ruberg RL. Management of gastrointestinal fistulas with parenteral hyperalimentation. Surgery 1973;74:100-5.

12. Chapman R, Foran R, Dunphy JE. Management of intestinal fistulas. Am J Surg 1964;108:157-64.

13. Thoeny RH, Hodgson JR, Scudamore HH. The roentgenologic diagnosis of gastrocolic and gastrojejuno- colic fistulas. AJR 1960;83:876-81.

14. Janes RM, Mills JR. Malignant duodenocolic fistula--report of a case treated successfully by mass resection. Can J Surg 1959;3:91-2.

15. Couinad C, Biotois H, Hidden G, Fine A. Les fistules duod6no-coliques par cancer colique. Chirurgie 1971; 97:459-64.

A n n o u n c e m e n t

C O N T I N U I N G MEDICAL E D U C A T I O N SEMINAR

A continuing medical education seminar entit led "Current Controver- sies in Crohn's Disease" will be held at the Baptist Memorial Hospital, Memphis, Tennessee, Apri l 30 and May 1, 1982. Attendance is limited to 250 persons. The Program Director is Richard O. Bicks, M.D. AMA PRA Category 1 accreditation is pending. For addit ional information, contact: Anne Wallace, Educational Suppor t Services, Baptist Memorial Hospital, 899 Madison Avenue, Memphis, Tennessee 38146. Telephone: 1-800- 238-6893.