Computed Tomography Evaluation of Malignant Internal Fistulas in Colonic Adenocarcinoma: A Case Series with Emphasis on Rare Colojejunal Fistulas
Santosh Kumar Panda, Madhuri Panigrahi, Akhyaya Kumar DashAbstract
Background:
Malignant internal fistulas of colon are the complications of advanced colonic carcinoma. Preoperative identification of the fistulas and assessment of local tumor extent are important for surgical planning. This study aimed to evaluate the role of contrast-enhanced computed tomography (CECT) in the diagnosis of malignant internal fistulas secondary to colonic adenocarcinoma.
Materials and Methods:
We conducted a retrospective case series of five patients with histopathologically proven colonic adenocarcinoma and CT-demonstrated internal fistulas at a tertiary care teaching hospital in Odisha, India. Clinical, ultrasonographic, endoscopic, colonoscopic, histopathological, and CT findings were reviewed. CT images were evaluated for fistula type, fistula size, tumor extent, adjacent organ invasion, lymphadenopathy, and metastatic disease.
Results:
Five male patients aged 26–70 years (mean age: 49.6 years) were included. The fistula types identified were colojejunal (
Conclusion:
Malignant internal fistulas are the rare manifestations of advanced colonic adenocarcinoma. Colojejunal fistulas are particularly uncommon. CECT plays an important role in detecting fistulous communications, assessing local disease extent, and identifying adjacent organ invasion, especially when endoscopic evaluation is limited.