title: A case of gastrojejunocolic fistula with steatohepatitis.
abstract: A man in his 30s, who had undergone retrocolic Billroth II reconstruction for perforated duodenal ulcer, presented with watery diarrhea for 2 years and suspected fatty liver. He was referred to our hospital for management of chronic diarrhea, weight loss, hepatopathy and hypoalbuminemia. Initial upper and lower gastrointestinal endoscopies were negative. Since a small bowel lesion was suspected, peroral single-balloon enteroscopy was performed, which identified feces-like residue near the Billroth II anastomotic site and a connection to the colon separate from the afferent and efferent loops. Transanal single-balloon enteroscopy identified a fistula between the gastrojejunal anastomosis and transverse colon, with the scope reaching the stomach transanally. Barium enema confirmed flow of contrast medium from the transverse colon through the fistula to the anastomotic site, allowing the diagnosis of gastrojejunocolic fistula. Liver biopsy showed relatively severe steatohepatitis (Brunt's classification: stage 2-3, grade 3). Resection of the anastomotic site and partial transverse colectomy were performed to remove the fistula, followed by Roux-en-Y reconstruction. Postoperatively, watery diarrhea resolved and the stools became normal. Hepatopathy and hypoproteinemia improved. One year later, liver biopsy showed marked improvement of steatosis. This case demonstrated marked improvement of both diarrhea/nutritional status and steatohepatitis after treatment of gastrojejunocolic fistula, suggesting that the fistula caused non-alcoholic steatohepatitis.
authors.affiliation: Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. tohmori@ige.twmu.ac.jp.
authors.forename: Teppei
authors.initials: T
authors.lastname: Omori
authors.affiliation: Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Tokushige
authors.affiliation: Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Fukiko
authors.initials: F
authors.lastname: Kinoshita
authors.affiliation: Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Ito
authors.affiliation: Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Taniai
authors.affiliation: Institute of Gastroenterology Surgery, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Mikiko
authors.initials: M
authors.lastname: Taneichi
authors.affiliation: Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Bunei
authors.initials: B
authors.lastname: Iizuka
authors.affiliation: Institute of Gastroenterology Surgery, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Itabashi
authors.affiliation: Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Nagashima
authors.affiliation: Institute of Gastroenterology Surgery, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
authors.forename: Etsuko
authors.initials: E
authors.lastname: Hashimoto
mesh_terms: D000328:Adult; D000071087:Balloon Enteroscopy; D001706:Biopsy; D003108:Colonic Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D004381:Duodenal Ulcer / Q000601:surgery; D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D005747:Gastric Fistula / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005763:Gastroenterostomy / Q000009:adverse effects; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D007579:Jejunal Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008099:Liver / Q000473:pathology; D008297:Male; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography / Q000379:methods
keywords: Gastrojejunocolic fistula; Small intestinal bacterial overgrowth; Steatohepatitis