Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment
Dogukan Dogu, Nezih Akkapulu, Sinan Efe Yazici, Altan Kavuncuoglu
Department of General Surgery, Hacettepe University Hospital, Ankara, Turkey
Am J Case Rep 2021; 22:e928532
Available online: 2020-12-23
Enterocutaneous fistula is an abnormal communication between the gastrointestinal tract and skin. One-third of enterocutaneous fistulas disappear spontaneously, but the rest of them require surgical treatment.
CASE REPORT: We describe the case of a 34-year-old woman with enterocutaneous fistula that she had had for year. She had previously undergone 2 unsuccessful operations, and the fistula recurred twice. Distal subtotal gastrectomy and Billroth 2 reconstruction were performed. In the pathological examination, the distal gastrectomy specimen revealed foci of ulceration. Well-circumscribed non-necrotizing granulomas were occasionally encountered beneath the ulcers.
CONCLUSIONS: Failure of treatment in recurrent fistula management has a variety of reasons. Our clinical experience shows that granulomatous gastritis can be a complicating factor in treatment of recurrent enterocutaneous fistula.
Keywords: celiac disease, Gastrectomy, Granuloma, Giant Cell, Intestinal Fistula