Jejunocecal fistula combined with gastro-ascending colonic fistula in a child with chronic diarrhea and weight loss: a case report.
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BACKGROUND: Gastrointestinal fistulas in children are rare, and the coexistence of a jejunocecal and gastric ascending colon fistula is exceptional. To our knowledge, no instance of this fistula combination has been reported previously. These patients present with nonspecific symptoms, which may lead to delayed or missed diagnoses. CASE PRESENTATION: We evaluated a 12-year-old boy with a 3-year history of intermittent nausea and vomiting, and a weight loss of 30 kg. Initially, he was managed as for gastroenteritis; however, his response was minimal. Further investigation included endoscopy and contrast radiography; these studies identified an abnormal communication between the stomach and colon; however, the exact anatomy remained elusive. Laparoscopy identified two fistulae: one between the greater curvature of the stomach and the ascending colon, and another between the jejunum and the cecum. The operation was converted to open due to dense adhesions. Resection of the fistulous tracts and repair (stomach) or anastomosis (small intestine and colon) were performed. Histopathology showed chronic inflammation with mucosal metaplasia but no evidence of malignancy. Retrospectively, the patient and family recalled prior play with magnets, but ingestion could not be confirmed. CONCLUSIONS: In children with chronic symptoms, such as recurrent diarrhea with weight loss, a gastrointestinal fistula should be considered. Use of contrast radiography and endoscopy, together with clinical correlation, may prevent misdiagnosis and delayed in treatment.