A Case of Transverse Colon Cancer with a Duodenocolic Fistula

Tsunehiko Maruyama, Mutsumi Nozue*, Hiroyuki Aoyagi**, Masataka Fukue** and Fumito Imamura**

Department of Surgery, Moriya Daiichi General Hospital
Department of Surgery, Shonai Amarume Hospital*
Department of Surgery, Tsukuba Memorial Hospital**

A 70-year-old man admitted for tarry stools was found in blood tests to be anemic and have markedly high tumor markers. Gastroduodenal fiberscopy showed a type 2 tumor in the second portion of the duodenum, found to be moderately differentiated adenocarcinoma on biopsy. CT showed a tumor around the right wall of the duodenum invaginating the transverse colon. Another tumor was apparent in the spleen. The barium enema showed complete obstruction of the hepatic flexure of the transverse colon. Angiography showed that a nutrient tumor vessel had branched from the middle colic artery, strongly suggesting transverse colon cancer. We conducted pancreaticoduodenectomy, right hemicolectomy, and splenectomy, and when a hepatic tumor became evident during surgery, partial hepatectomy. Transverse colon cancer with formation of a duodenocolic fistula with splenic and hepatic metastasis was the definitive diagnosis. Although peritoneal and hepatic metastasis led to death 30 months postoperatively, long-term survival for colon cancer patients with a duodenocolic fistula may be achieved by the radical excision described above.

Key words
colon cancer, malignant duodenocolic fistula, pancreaticoduodenectomy

Reprint requests
Tsunehiko Maruyama Department of Surgery, Moriya Daiichi General Hospital
1-17 Matsumaedai, Moriya, 302-0102 JAPAN

Accepted
November 30, 2004

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