Repairing a remote complication of abdominal penetrating trauma: diagnosis and management of a debilitating gastrocolic fistula

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A young adult with a body mass index (BMI) of 16.5 was admitted to the hospital with mild abdominal pain and failure to thrive. Four years earlier, the patient sustained a right-to-left abdominal gunshot wound, injuring the first portion of the duodenum, pancreas, jejunum, and colon. Their surgical history was somewhat unclear but, from sparse operative reports, we surmised that they underwent a damage control laparotomy followed by multiple small bowel resections, Roux-en-Y gastrojejunostomy, primary repair of the duodenum, partial colectomy, common bile duct exploration, cholecystectomy, diverting loop ileostomy, and eventual ileostomy takedown. Throughout the year prior to admission, the patient lost over 50 pounds and had emergency room visits for chronic abdominal pain, diarrhea, weakness, and weight loss, despite adequate oral intake. Prior clinicians diagnosed the patient with enteritis and encouraged increased per os intake with nutrient-rich dietary supplements. The patient presented to our hospital for a second opinion given worsening cachexia, weakness, and abdominal symptoms.

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