title: Rare finding of a gastrojejuno appendicular fistula during a laparotomy for roux-en-y conversion.
abstract: Gastrojejuno appendicular fistula is a rare condition. To our knowledge it has not been reported previously in the literature. We report the first case of a gastrojejuno appendicular fistula occurring in a patient who had previous gastroenterostomy for ulcer disease. He presented to us with recurrent episodes of abdominal pain and bilious vomiting. An endoscopy revealed intense gastritis with bile reflux. He was diagnosed as alkaline gastritis and put on medication. As there was no relief of his symptoms; it was decided to do a biliary diversion. At laparotomy there were extensive adhesions which was gently separated. Patient had an anticolic anastomosis and a long tubular structure was seen fistulating to the stoma site. It was traced and found to be the appendix. The gastrojejunal stoma was opened and the fistulous mouth was identified and cannulated following, which a retrograde appendicectomy was performed and a cuff of intestine around the fistula was excised. The Stoma was closed in a single layer. A Braun's enteroenterostomy was done to correct the alkaline reflux. The patient is symptomatically better and is gaining weight. The pathogenesis of alkaline gastritis. appendicular fistula and gastrojejunocolic fistula is discussed.
authors.affiliation: Sri Ramachandra University, Porur, Chennai 6000116, India.
authors.forename: Cunnigaiper Dhanasekaran
authors.initials: CD
authors.lastname: Narayanan
authors.forename: Achi Ranganath
authors.initials: AR
authors.lastname: Bhaskarapprakash
authors.forename: Balakumar
authors.initials: B
authors.lastname: Vijay
authors.forename: Shanthi
authors.initials: S
authors.lastname: Vijayaraghavan
authors.forename: Varadachari
authors.initials: V
authors.lastname: Srinivasan
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D001065:Appendix; D002429:Cecal Diseases / Q000209:etiology*; D016154:Digestive System Fistula / Q000209:etiology*; D013505:Digestive System Surgical Procedures; D005763:Gastroenterostomy / Q000009:adverse effects*; D006801:Humans; D007579:Jejunal Diseases / Q000209:etiology*; D007813:Laparotomy; D008297:Male; D010437:Peptic Ulcer / Q000601:surgery; D013272:Stomach Diseases / Q000209:etiology*