GASTROCOLIC FISTULAS - THE INCREASING ROLE OF ASPIRIN

Eight patients had gastrocolic fistulas depicted on barium studies at the authors' hospital during a 10-year period between 1982 and 1992. S even of those patients (88%) had benign disease, including aspirin-ind uced gastric ulcers of the greater curvature (n = 4), granulomatous co litis (n = 1), tuberculosis (n = 1), and a penetrating anastomotic ulc er after partial gastrectomy (n = 1). The remaining patient had a mali gnant gastrocolic fistula caused by carcinoma of the transverse colon. Two patients (25%) experienced classic symptoms of gastrocolic fistul as (ie, feculent vomiting or foul-smelling eructations), but the other six (75%) experienced abdominal pain or other nonspecific clinical fi ndings. In the four patients who were taking aspirin, upper gastrointe stinal examinations revealed giant penetrating ulcers of the greater c urvature that communicated with the superior border of the transverse colon via a fistula. Three of these patients exhibited marked clinical improvement after conservative medical treatment and did not need sur gery. This experience suggests that aspirin-induced gastric ulcers of the greater curvature have become a more common cause of gastrocolic f istulas than is carcinoma of the stomach or transverse colon.