S5260 Severe Malnutrition and Diarrhea Due to Gastrocolic Fistula Post–Roux-en-Y: Role of Endoscopic Stenting in Bridging to Surgery

Introduction: Gastrocolic fistula is a rare and serious problem that may occur after gastrointestinal surgery. It usually presents with chronic diarrhea and severe malnutrition. Although endoscopic interventions could act as a link to definitive surgical treatment, outcomes for severely debilitated patients remain poor. We report a case of a large size gastrocolic fistula that occurred after Roux-en-Y reconstruction and proved fatal, even with endoscopic stenting. Case Description: A 56-year-old man presented with symptoms of generalized weakness, cachexia, severe chronic diarrhea, and a history of perforated duodenal ulcer status post Roux-en-Y gastrojejunostomy, several surgical revisions, Crohn's disease and hepatitis C virus (HCV) disease. Initially, the patient was treated based on symptoms. All necessary laboratory tests were conducted, including a slightly elevated fecal calprotectin and fecal analysis, which eliminated the possibility of an infectious cause. An endoscopy revealed a large gastrocolic fistula near the gastrojejunal anastomosis, as well as a clean-based marginal ulcer spanning the mid-gastric body to the transverse colon. Protein-calorie malnutrition was evident, so total parenteral nutrition was recommended. The patient left the hospital against doctors' advice, but was later readmitted as symptoms got worse. Repeated EGD revealed a common fistulous cavity involving the colon and jejunum. A self-expandable metallic stent (18 mm × 149 mm) was placed via endoscopy to bridge the gastrojejunal and jejunojejunal anastomoses and cover the fistula. Subsequently, the patient showed signs of stabilization and leakage of contrast was not detected during fluoroscopy. This stenting was performed to stabilize the patient for subsequent surgical intervention. Despite the successful endoscopic intervention, severe malnutrition and systemic deconditioning worsened the patient's condition. The patient succumbed within 20 days, before planned surgical intervention or stent removal. Discussion: This case highlights the serious consequences of enteric fistula formation in post-surgical patients, especially when accompanied by chronic malnutrition and systemic illness. Although endoscopic stenting can be used as a temporary measure, survival rates are low without adequate nutritional reserves and timely definitive surgery. This case emphasizes the importance of early detection, nutritional support, and close interdisciplinary management for patients suffering from complex post-surgical GI complications.