title: Malignant sigmoidoduodenal fistula.
abstract: BACKGROUND
  Duodenocolic fistula is a rare complication of malignant colonic disease especially when involving and originating from the sigmoid colon. We aim to discuss the unusual clinical presentation of this case as well as the investigation and management of duodenocolic fistulas.
  
  
  METHODS
  A 91 year old lady presented as an emergency to a general surgical service at a District General Hospital with diarrhoea, vomiting and weight loss. Computed Tomography (CT) reported a large ovarian cyst elevating the sigmoid colon into immediate proximity of the duodenum. Adenocarcinoma was confirmed on histology obtained by colonoscopy. A classic apple core lesion with fistulating tract from the sigmoid colon to the duodenum was synchronously demonstrated on barium enema.
  
  
  CONCLUSIONS
  Sigmoido-duodenal fistulae represent a complex manifestation of gastrointestinal pathologies.
  
  
  CONCLUSIONS
  Management options must be considered in the context of patient wishes, their co-morbidities, and predicted post-operative outcome. In most cases this is likely to represent a non-operative approach, however surgical resection may benefit selected cases on occasion.
authors.affiliation: Tameside General Hospital, Fountain Street, Ashton-under-Lyne OL6 9RW, United Kingdom. Electronic address: i.m.shapey@doctors.org.uk.
authors.forename: I M
authors.initials: IM
authors.lastname: Shapey
authors.affiliation: Tameside General Hospital, Fountain Street, Ashton-under-Lyne OL6 9RW, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: Mahmood
authors.affiliation: Tameside General Hospital, Fountain Street, Ashton-under-Lyne OL6 9RW, United Kingdom.
authors.forename: M H
authors.initials: MH
authors.lastname: Solkar
keywords: Colorectal cancer; Duodenocolic fistula; Sigmoidoduodenal fistula