A Case of Gastrojejunocolic Fistula Following Subtotal Stomach-preserving Pancreaticoduodenectomy with Undernutrition, Efficiently Managed Via Indirect Calorimetry

Gastrojejunocolic fistula is a rare but serious complication of pancreaticoduodenectomy that can lead to malabsorption and severe undernutrition. A 59-year-old man presented with leg edema and significant weight loss 8 years after undergoing subtotal stomach-preserving pancreaticoduodenectomy. After preoperative nutritional improvement (guided by indirect calorimetry), the patient underwent fistula resection and Roux-en-Y reconstruction. The patient was discharged on postoperative day 37, and his nutritional parameters remained adequate at the one-year follow-up. This case demonstrates the validity of indirect calorimetry in optimizing nutrition, preventing refeeding syndrome, and managing perioperative care in patients with gastrojejunocolic fistulas after pancreaticoduodenectomy.