An unusual presentation of gastric fistula following peptic perforation repair: A case report

• Published in: International journal of surgery case reports 2019-01, Vol.56, p.29-31
• Main Authors: Kumar Sinha, Mithilesh, Mohakud, Sudipta, Mishra, Tushar Subhadarshan, Barman, Apurba
• Format: Article
• Language: English
• Subjects: Gastric fistula; Gastrocutaneous fistula; Peptic perforation
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2019.01.032

•Late onset Gastrocutaneous fistulas are rare following the peptic perforation repair.•A non-healing burst abdominal wound should be thoroughly investigated. It can be because of an underlying fistula.•CT fistulogram is the investigation of choice to confirm the diagnosis.•Operative intervention is difficult but the only method of cure in most of the circumstances. Peptic perforation repair is a common stomach surgery. This surgery has not been associated with delayed onset gastrocutaneous fistula formation. However such a complication has been reported following a variety of other stomach surgeries. We are reporting this case as it is a rare complication. Also its diagnosis and management is challenging. We are presenting a case of peptic perforation repair where burst abdomen happened in the immediate post-operative period. The patient was put on conservative management. He responded well to it but his abdominal wound was not healing. After a wait of four months the wound was covered with a skin graft. The graft uptake was satisfactory but a discharging ulcer appeared on it. This condition persisted for one month. Finally a computed tomography Fistulogram (CT Fistulogram) was performed. It revealed an underlying complex gastric fistula. A repeat surgery was performed. A gastrocutaneous fistula diagnosed at sixth month following the peptic perforation repair and causing minimal discomfort to the patient is a rare presentation. The abdominal wound following the surgery was possibly not healing because of the underlying fistula.