Jejunocolic fistula associated with an intestinal T cell lymphoma

Malignant recto-jejunal fistula: a rare case report

Introduction and importance

Malignancy can lead to colo-enteric fistulas. A malignant fistula between the rectum and the jejunum is a rare occurrence.

Case presentation

A 60-year-old female suffered from diarrhea, vomiting, and epigastric pain for 4 months. After demonstration of a dilated rectum with heterogeneous collection on ultrasonography, contrast-enhanced computed tomography (CECT) along with rectal contrast was done, which showed heterogeneously enhancing asymmetrical circumferential thickening of the proximal rectum, including rectosigmoid junction, collection in the rectum and two recto-jejunal fistulous tracts. Colonoscopy showed ulcero-proliferative growth in the rectum with two fistulous tracts communicating with the jejunum. Biopsy from the growth indicated a poorly differentiated adenocarcinoma. Conservative and palliative treatment was provided.

Clinical discussion

Clinical features of colo-enteric fistulas can include abdominal pain, diarrhea, and weight loss. The patient may be asymptomatic in some cases. Options for diagnosis include barium studies, enteroscopy, colonoscopy, CECT, and computed tomography enterography (CTE). Malignant bowel fistula is associated with serious complications resulting in high morbidity and mortality rates. Surgical resection and fistula repair are the mainstay of curative treatment.

Conclusion

Long-standing gastrointestinal symptoms like chronic diarrhea in the elderly should be investigated with imaging modalities like CECT. Early detection with imaging can reduce debilitating metabolic and nutritional deficiencies and improve patient's morbidity and mortality.

Jejunocolic fistula presenting as chronic diarrhoea from advanced lymphoma

Jejunocolic fistula, a late complication of intestinal lymphoma, is a rare entity with only five reported cases in the literature. We report a young male presenting with a left lateral neck mass 5 years ago which then progressed to superior vena cava syndrome. Despite receiving radiotherapy and two cycles of chemotherapy, there was still tumour progression. He presented with a 2-week history of diarrhoea, haematochezia and weight loss for which antibiotics provided no relief. Esophagogastroduodenoscopy and colonoscopy showed a jejunocolic fistula. After discussion with the multidisciplinary team, nutritional upbuilding was initiated followed by exploratory laparotomy with segmental resection and anastomosis. On histopathology, diffuse large B-cell lymphoma involving the jejunum and colon was noted. Despite receiving palliative chemotherapy, he still succumbed to disease progression. This case highlights the importance of early recognition of jejunocolic fistulas among patients with intestinal lymphomas to facilitate early multidisciplinary intervention.

Intestinal T-cell lymphoma: A rare entity presenting with severe acute upper quadrant pain

Primary gastrointestinal T-cell lymphomas are rare. Presenting symptoms can be non-specific, and imaging studies can show overlap with nonmalignant processes. Definitive diagnosis requires clinical suspicion and histologic evaluation with ancillary studies for appropriate disease classification and therapeutic intervention.

Ileo-Colonic Fistula Due to Diffuse Large B Cell Lymphoma: Unusual Presentation of a Rare Disease

Malignant ileocolonic fistulas have seldom been documented as complications of a primary gastrointestinal lymphoma (PGIL) such as aggressive diffuse large B cell lymphoma (DLBCL). These fistulas are frequently misdiagnosed due to the nonspecific clinical presentation. Currently, there is no standardized treatment approach, although a couple have been suggested with varying outcomes. We describe a case of DLBCL complicated with a malignant ileocolonic fistula in a 55-year-old male with a favorable outcome after surgery and chemotherapy.

Rare intestinal fistula caused by primary lymphoma of the gastrointestinal tract: Two case reports and literature review

RATIONALE

Primary lymphoma that arises from the intestine is an uncommon malignant tumour, while intestinal fistula caused by primary lymphoma is even rarer. Non-specific clinical performance makes early diagnosis difficult, although imaging modalities might play an essential role in the detection of intestinal fistula.

PATIENT CONCERNS

Patient 1: A 60-year-old male hospitalized with diarrhoea and abdominal pain for seven months underwent computed tomography enterography (CTE) that demonstrated ileum internal fistula and ileac-sigmoid colon fistula. Ultrasound (US) showed small intestinal wall thickened and development of a fistula of the sigmoid colon due to malignance. Patient 2: A 43-year-old male presented with abdominal pain and diarrhoea lasting one year. US revealed a fistula between the sigmoid colon and the ileum, and CTE showed that the wall of the partial sigmoid colon was abnormally thickened and enhanced with an ileal-sigmoid fistula that strongly suggested the diagnosis of lymphoma.

DIAGNOSES

Both the two patients were diagnosed as intestinal fistula caused by primary non-Hodgkin's intestinal lymphoma.

INTERVENTIONS

The patient 1 underwent surgery followed by chemotherapy. The patient 2 accepted chemotherapy.

OUTCOMES

Two patients' general conditions remained stable and the imaging revealed no recurrence after follow-up of about 12 months.

LESSIONS

Cross-sectional imaging, such as US and CT, plays an essential role in intestinal lymphoma fistula diagnosis.

Tumor-bowel fistula: what radiologists should know

Tumor-bowel fistula is an under reported complication of abdomino-pelvic malignancies which may occur spontaneously due to tumor growth or can be associated with cancer treatment. Chemotherapy and radiotherapy are commonly responsible for tumor-bowel fistulas. Molecular targeted therapies are a new class of drugs that can cause tumor fistulization due to their antiangiogenic properties. Clinically, the fistula can be asymptomatic or can result in devastating complications. Imaging helps in the prompt detection of these fistulas and the complications associated with them. Management of tumor-bowel fistula is individualized but often involves discontinuation of the associated treatment. Radiologists should promptly alert the oncology team about the presence of tumor-bowel fistula and any risk factors for its occurrence like pneumatosis or large metastatic deposits close to bowel loops.

Development of enterohepatic fistula after embolization in ileal gastrointestinal stromal tumor: A case report

Gastrointestinal stromal tumor (GIST) is a rare mesenchymal tumor of the gastrointestinal tract that has been associated with the formation of fistulas to adjacent organs in few case reports. However, GIST with enterohepatic fistula has not been reported. Here we report the case of an enterohepatic fistula that occurred after embolization of a liver mass originating in the distal ileum. An 87-year-old woman was hospitalized for melena. On initial conventional endoscopy, a bleeding focus in the gastrointestinal tract was not found. Because of massive hematochezia, enteroscopy was performed through the anus. A protruding, ulcerative mass was found in the distal ileum that was suspected to be the source of the bleeding; a biopsy sample was taken. Electrocoagulation was not successful in controlling the bleeding; therefore, embolization was performed. After embolization, the patient developed a high fever and severe abdominal tenderness with rebound tenderness. Follow-up abdominopelvic computed tomography revealed an enterohepatic fistula between the liver and distal ileum. The fistula was treated surgically by segmental resection of the distal ileum and unlooping of the liver mass.