Duodenocolic Fistulas

Although most duodenocolic fistulas result from an infiltrating adenocarcinoma of the hepatic flexure,11 the communication may be established by ulcerative or inflammatory disease.1214 Granulomatous colitis is being increasingly recognized as an underlying cause.13,14 With the right-sided colonic involvement of this transmural inflammatory and ulcerating condition, fistulization may develop between the hepatic flexure particularly or the transverse colon and the duodenum (Figs. 10-14 through 10-16). Malabsorption may result if the small bowel is bypassed significantly, but the fistula need not be a serious complication of Crohn's disease and should not serve as an indication for surgical correction for its own sake.13-15 Intestinal tuberculosis is another chronic granulomatous disease that may result in fistulization16,17

Duodenocolic Fistula Proximal Transverse Colon

Fig. 10—10. Lymphangitic cysts within the leaves of the transverse mesocolon producing extrinsic nodular indentations on the descending duodenum.

(a) Prone. Three discrete mass impressions are shown (arrows).

(b) Right lateral projection. The larger, more proximal indentation presents on the anterior aspect of the descending duodenum (arrowheads). Note its relationship to the hepatic flexure of the colon (C).

(c) Cysts within the mesocolon leaves bridging the bare area of the descending duodenum. (Reproduced from Meyers and Whalen.1)

Fig. 10—10. Lymphangitic cysts within the leaves of the transverse mesocolon producing extrinsic nodular indentations on the descending duodenum.

(a) Prone. Three discrete mass impressions are shown (arrows).

(b) Right lateral projection. The larger, more proximal indentation presents on the anterior aspect of the descending duodenum (arrowheads). Note its relationship to the hepatic flexure of the colon (C).

(c) Cysts within the mesocolon leaves bridging the bare area of the descending duodenum. (Reproduced from Meyers and Whalen.1)

Fig. 10-11. Carcinoma of the hepatic flexure adherent to the descending duodenum.

Upper GI series shows pressure effects on the duodenum by a nodular malignancy within the hepatic flexure outlined by gas. At surgery, this required careful dissection.

Paraduodenal Area And Picture

Fig. 10-12. Adherence of colonic carcinoma to duodenum.

Computed tomography shows early adhesive contiguity (arrow) to the inferior genu of the duodenum (D) of a carcinoma that thickens the wall of the hepatic flexure of the colon (C). Thickening of the anterior renal fascia and increased reticulation through the perirenal fat are noted.

Perirenal Fat

Fig. 10—13. Extension of colonic carcinoma across the mesocolon to the paraduodenal area.

(a) Upper gastrointestinal series reveals numerous gas-containing abscess cavities (arrows) within a mass in the area of the head of the pancreas. There are edema and distortion of the mucosal folds of the descending duodenum.

(b) A subsequent barium enema shows a primary infiltrating carcinoma of the anterior hepatic flexure with a pericolonic-paraduodenal abscess.

Fig. 10—13. Extension of colonic carcinoma across the mesocolon to the paraduodenal area.

(a) Upper gastrointestinal series reveals numerous gas-containing abscess cavities (arrows) within a mass in the area of the head of the pancreas. There are edema and distortion of the mucosal folds of the descending duodenum.

(b) A subsequent barium enema shows a primary infiltrating carcinoma of the anterior hepatic flexure with a pericolonic-paraduodenal abscess.

(Fig. 10-17). A similar duodenocolic fistula may be seen as a postoperative complication (Fig. 10-18).

Examples have been described of fistulous communication between the third part of the duodenum and the transverse colon, which contained a well-marked muscular layer and an intact epithelium. This rare variety is presumably on an embryologic basis.18

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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