Giordano Rafael Tronco Alves1*, John Neoptolemos2, Natalia Henz Concatto3, Bruno Hochhegger4 and Klaus Loureiro Irion5
1Post-graduation Program in Medicine (Radiology), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
2Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
3Radiology Division, University of Caxias do Sul, Caxias do Sul, Brazil
4Department of Radiology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
5Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK
Received: 30 October, 2014; Accepted: 19 March, 2015; Published: 21 March, 2015
Giordano R. T. Alves, M.D, Post-graduation Program in Medicine (Radiology) from the Federal University of Rio de Janeiro, Professor Rodolpho Paulo Rocco Street, 255, ZC: 21941-913, Rio de Janeiro, Brazil, Tel: 555599159009; Fax: 555599159009; E-Mail:
Tronco Alves GR, Neoptolemos J, Concatto NH, Hochhegger B, Irion KL (2015) Coloduodenal Fistula: The Role of MDCT on Diagnosing a Rare Entity. Imaging J Clin Med Sciences 2(1): 004-005. DOI: 10.17352/2455-8702.000017
© 2015 Tronco Alves GR, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Coloduodenal fistula is a very infrequent complication, which can arise from both benign and malignant diseases. It consists in a pathological communication between the lumen of the colon and duodenum. The onset of signs and symptoms is generally sub-acute, and the majority of the patients will present with a non-specific abdominal pain, diarrhoea, nausea and vomiting . Nevertheless, the clinical presentation may vary significantly - depending on the site of fistulisation - and some cases may never be diagnosed.
When not clinically suspected, cross-sectional imaging studies can be the only tool to suggest the diagnosis and provide information necessary for deciding among therapeutic options . In this article, we report a case of coloduodenal fistula arising from a colonic malignancy, diagnosed by multi-detector computed tomography scan (MDCT). A brief discussion regarding the condition and its diagnostic challenges is presented.
A 60-year-old male, ex-smoker, was admitted complaining of weight loss and tiredness for one year. He also complained of recent onset of abdominal discomfort and diarrhoea. Past medical history was otherwise unremarkable, except for chronic hypertension and type-2 diabetes mellitus. A palpable mass was noted in the right flank. Normocytic normochromic anaemia was detected on haemogram, suggesting the presence of an underlying chronic disease.
Colonoscopy revealed multiple colonic polyps and a mass in the ascending colon. Adenocarcinoma of the colon was confirmed on histopathology. MDCT imaging (Figure 1, A-axial, B-coronal and C-sagittal views, C=colon / D=duodenum and GB=gallbladder) shows a mass in the ascending colon, with infiltration of the adjacent fat and duodenal invasion with a large fistulous tract communicating the lumen of these two segments of the bowel loops (indicated by arrows). Liver metastases and enlarged abdominal nodes were also demonstrated.
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