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Case Reports: Rare disease
Jejunocolic fistula presenting as chronic diarrhoea from advanced lymphoma
  1. Rogelio N Velasco, Jr.1,
  2. Mark M Ando1,
  3. Hashamiiya M Babaran2,
  4. Ma. Corazon C Manuntag3 and
  5. Dennis Lee Sacdalan1
  1. 1Division of Medical Oncology, Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines
  2. 2Division of Gastroenterology, Department of Medicine, Philippine General Hospital, Manila, Philippines
  3. 3Department of Surgery, Philippine General Hospital, Manila, Philippines
  1. Correspondence to Dr Rogelio N Velasco, Jr.; rogervelascojr{at}gmail.com

Abstract

Jejunocolic fistula, a late complication of intestinal lymphoma, is a rare entity with only five reported cases in the literature. We report a young male presenting with a left lateral neck mass 5 years ago which then progressed to superior vena cava syndrome. Despite receiving radiotherapy and two cycles of chemotherapy, there was still tumour progression. He presented with a 2-week history of diarrhoea, haematochezia and weight loss for which antibiotics provided no relief. Esophagogastroduodenoscopy and colonoscopy showed a jejunocolic fistula. After discussion with the multidisciplinary team, nutritional upbuilding was initiated followed by exploratory laparotomy with segmental resection and anastomosis. On histopathology, diffuse large B-cell lymphoma involving the jejunum and colon was noted. Despite receiving palliative chemotherapy, he still succumbed to disease progression. This case highlights the importance of early recognition of jejunocolic fistulas among patients with intestinal lymphomas to facilitate early multidisciplinary intervention.

  • oncology
  • malnutrition
  • nutritional support
  • gastrointestinal surgery

https://doi.org/10.1136/bcr-2021-245495

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    Footnotes

    • Contributors RJV conceptualised the study, obtained the informed consent and drafted the final manuscript. MA drafted and revised the final version of the manuscript. MC contributed in the discussion of the case in the manuscript. HB collected the relevant images and revised the final version of the manuscript. DLS spearheaded the project and revised the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.