Factors precipitating the formation of the fistula may include:
(1) endoscopic gastrostomy or placement of a gastrostomy tube
(2) penetratring abdominal trauma
(3) gastric or colonic carcinoma
(4) peptic ulcer disease
(5) coronary artery bypass surgery using the gastroepiploic artery
(6) Crohn's disease
(7) perforated diverticulum
(8) infectious disease (tuberculosis, syphilis, amebiasis, etc)
(9) following gastric surgery (gastrojejunostomy, other)
(10) pancreatic abscess
(11) Hodgkin's disease
Clinical findings may include:
(1) transient or persistent diarrhea
(1a) resistant to standard therapy
(1b) may be triggered by eating or by a feeding
(1c) may be watery
(1d) may contain undigested food or enteric feeding solution
(2) vomiting of fecal material (feculent vomiting)
(3) unintended weight loss and malnutrition
(4) abdominal pain
Diagnosis may be made by:
(1) gastroscopy or colonoscopy
(2) contrast studies (upper GI or barium enema)
(3) CT scan or MRI
However, the diagnosis can be missed if the fistula is small or the diagnosis is not suspected.
