Victor Wang, MD, MPH; David M. Dorfman MD, PhD; Shilpa Grover, MD; David L. Carr-Locke MD, FRCP, FACG, FASGE


February 07, 2007

Introduction and Case Report


Enterocolic fistulas are usually caused by inflammatory conditions such as inflammatory bowel disease (eg, Crohn's disease). This abnormal communication can also be caused by prior surgery, foreign bodies, pancreatitis, diverticulitis, and, most ominously, by malignancy.

The following case describes an elderly patient with failure to thrive and new-onset diarrhea who underwent colonoscopic examination; findings on colonoscopy revealed a large intestinal lymphoma with an associated enterocolic fistula.

Case Report

An 86-year-old woman presented with an acute diarrheal illness starting 10 days prior to admission. She described 3 to 4 daily episodes of large-volume nonbloody stools with occasional nocturnal episodes. She had occasional diffuse crampy abdominal pain without nausea, and had notable weight loss over the last month. She had daily fevers, chills, and night sweats. There was no recent use of antibiotics, no recent travel, and no history of exposure to sick contacts.

Her past medical history was significant for chronic obstructive pulmonary disease, a recent discovery of a left-sided lung mass with pleural effusion, chronic autoimmune hemolytic anemia, and cholelithiasis. There was no prior history of abdominal surgery. Her sister had colon cancer diagnosed late in life.

The patient was febrile to 101.6°F (38.7°C), with stable hemodynamic vital signs. She was cachetic but appeared nontoxic on exam, with a mildly protuberant abdomen with normal active bowel sounds and no palpable tenderness. Her laboratory tests showed normal electrolytes, serum calcium, thyroid-stimulating hormone, and hepatic panel. The complete blood count revealed a microcytic anemia. The infectious diarrhea work-up was negative. A computed tomographic (CT) scan of the abdomen with oral and intravenous contrast showed no specific abdominal masses or bowel wall abnormalities (not shown).


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