Gastrocolic Fistula and Gastric Ulcer With Prolonged Glucocorticoid Therapy

GASTROCOLIC FISTULAE result primarily from perforations through carcinomas of the colon or stomach. In the majority of cases the primary lesion is a far-advanced colon neoplasm. Rare causes of gastrocolic fistulae are benign gastric ulcers, carcinoid tumor of the colon,¹ and chronic ulcerative colotis.^2,3

Verbrugge⁴ reviewed the literature up to 1925 and found only 25 cases of benign gastric ulcer perforating into the colon. Gray⁵ found four additional cases listed up to 1955 and added one of her own. Bachman and Rogers⁶ in the same year reported a case of benign gastric ulcer with gastrocolic fistula. The patient was a 33-year-old woman who had been on corticosteroid therapy for three years for psoriasis and psoriatic arthritis. Until the gastrocolic fistula had occurred with resultant diarrhea, the patient had no apparent signs or symptoms of gastrointestinal difficulty. Bosien and Tyson,⁷ in 1952, reported a patient