benign duodenocolic fistula is a fistula between the duodenum and colon with no malignancy of either section .
however , the duodenocolic fistula complication of peptic ulcer has not been reported in the middle east .
diagnosis of duodenocolic fistula is always established with upper and lower gastrointestinal tract contrast studies .
regardless of the cause of duodenocolic fistula the best treatment is surgical modality . here , the case of a patient who was diagnosed with a duodenocolic fistula secondary to duodenal peptic ulcer underwent extended right hemicolectomy and duodenal wall en bloc resection is reported .
a 44-year - old caucasian male with a history of chronic upper abdominal pain , diarrhea and 25 kg weight loss in three months was admitted .
the patient had a history of dyspepsia and upper gastrointestinal ( gi ) bleeding 4 months before admission .
gastroduodenoscopy demonstrated a small ulcer in the lesser curvature and a large ulcer in duodenal bulb .
physical examination revealed cachexia , pale conjunctiva and scaphoid abdomen , with no palpable mass .
laboratory evaluations were in normal ranges except 10.1 gr / dl hb and 2.6 gr / dl albumin .
no obvious mass was observed in the entrance of scope from first part of the duodenum ( d1 ) into the colon and biopsies revealed no malignancy .
upper gi series with barium study revealed a duodenocolic fistula ( figure 1 ) . abdominal ct scan with oral contrast showed duodenal deformity without evidence of malignancy .
intraoperative findings were duodenocolic fistula between d1 and transverse colon with no mass in stomach , duodenum or colon .
the patient had complete relief from symptoms after surgery with a six months follow - up .
he found a fistula between duodenum and the mid - transverse colon , which was due to duodenal diverticulum . since then about 169 benign duodenocolic fistula cases have been reported in western countries .
mcpeak reported the first case of duodenal ulcer with fistula between duodenum and transverse colon .
he described two cases with d1 and d2 fistula and managed them with excision of fistula ( 3 ) .
since then , about 40 cases of duodenocolic fistula as a complication of peptic ulcer have been reported .
further cases were due to previous typhoid ulceration , ulcerative colitis , tuberculous mesenteric adenitis , duodenal diverticulum , iatrogenic trauma , spontaneous fistula , colon diverticulum , foreign body penetration , acute pancreatitis , acute appendicitis , hydatid cyst and acute cholecystitis .
patients usually suffer from chronic colicky abdominal pain , which is located in the epigastric region or the right hypochondrium .
patients usually have weight loss due to bacterial overgrowth , steatorrhoea , malnutrition , malabsorption and electrolyte disturbances .
almost always patients experience predominant motion of colonic contents through the fistula to the duodenum .
this is probably due to pyloric act as a barrier of retrograde flow of feces from duodenum to the stomach ( 6 ) . although the patient in the studied case had chronic abdominal pain , severe diarrhea with food particles and overt weight loss during 3 months ,
the important role of colonoscopy and gastroduodenoscopy is obtaining tissue sample for suspicious malignancy in the colon or duodenum .
barium enema is the most reliable with a sensitivity of over 90% than approximately 25% accuracy in upper gi studies ( 7 ) .
upper and lower endoscopies were performed because of patient 's previous history and alarm signs .
it was confirmed with upper gi barium study . due to endoscopic findings , barium enema was excluded .
duodenocolic fistula patients are usually malnourished and they usually need parenteral nutrition before surgery . before introduction of parenteral nutrition , outcome of such patients were not satisfactory ( 5 ) .
successful palliation of diarrhea with octreotide has been reported in malignant duodenocolic fistula ( 8) but the treatment of choice in benign duodenocolic fistula is surgery .
the duodenal defect is either closed primarily or repaired with serosal patch , depending on the defect size .
primary closure of the duodenum defect is the preferred treatment in the literature ( 9 ) .
other procedures include roux - en - y duodenojejunostomy , partial duodenal excision with gastrojejunostomy ( 10 ) . in malignant cases more extensive resection is usually needed . in some cases of crohn 's disease and tuberculosis , fistula closed spontaneously after medical treatment ( 11 , 12 ) .
primary closure of duodenum was possible and reconstruction with gastrojejunostomy was performed . although peptic ulcer disease is not uncommon , it 's a rare complication ; duodenocolic fistula has not been reported in iran previously . due to identical clinical presentation of duodenocolic fistula and malignancy , variant radiology modalities and endoscopy with biopsies are necessary before surgery .
surgery is the only curative treatment , after resection , reconstruction method is dependent on patient 's situation
. partial colectomy with en bloc excision of fistula and partial duodenectomy is the preferred treatment in most of these patients .
 a 44-year - old man with upper abdominal pain , diarrhea and 25 kg weight loss since 3 months ago was admitted . he had a history of dyspepsia and peptic ulcer disease 4 months before admission.gastroduodenal 
 endoscopy and upper gastrointestinal series with barium study were done . 
 biopsies and ct - scan ruled out malignancies . 
 endoscopy and radiology studies revealed a duodenocolic fistula . 
 he underwent right hemicolectomy , fistula en bloc excision , and distal gastrectomy surgery with gastrojejunostomy and ileocolic anastomosis . 
 radiologic modalities are necessary before surgery . 
 surgery is the only curative treatment in benign cases and reconstruction method is dependent on patient 's situation . 
Introduction
Case Report
Discussion