Case report: gastrocolic fistula mimicking Zollinger-Ellison syndrome.
Fasting serum gastrin levels greater than 1000 pg/ml are said to establish the diagnosis of gastrinoma in a patient with peptic ulcer disease. The authors observed a patient with recurrent peptic ulcer disease, diarrhea, and a fasting serum gastrin of 1044 pg/ml who had a gastrocolic fistula, not the Zollinger-Ellison syndrome. The provocative tests of gastrin secretion, including secretin infusion and standard meal test, were helpful in ruling out a gastrinoma. This is the first reported association of gastrocolic fistula and hypergastrinemia. The patient demonstrates that the differential diagnosis of markedly elevated serum gastrin should be expanded to include gastrocolic fistula.
Scofield
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Department of Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City 73190.
Kaufman
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CE
D000328:Adult; D003108:Colonic Diseases / Q000097:blood / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005747:Gastric Fistula / Q000097:blood / Q000175:diagnosis*; D005755:Gastrins / Q000097:blood*; D006801:Humans; D007412:Intestinal Fistula / Q000097:blood / Q000175:diagnosis*; D013276:Stomach Ulcer / Q000097:blood / Q000209:etiology; D015043:Zollinger-Ellison Syndrome / Q000097:blood / Q000175:diagnosis*
D005755:Gastrins