Duodenal stents as a rescue therapy to a malingant duodenocolonic fistula caused by hepatocellular carcinoma

Malignant duodenocolonic fistula is a rare complication of colorectal cancer. But here we have an experience with malignant duodenocolonic fistula caused by hepatocellular carcinoma. It occurs when a right hepatocellular carcinoma creates an abnormal connection between the duodenum and the hepatic flexure. Managing malignant duodenocolonic fistula depends on the extent and pattern of duodenal involvement. He is 77 years old man. He was treated for hepatocellular carcinoma(HCC). At that time he visited the ER because of hemoperitoneum. It was related that the HCC was ruptured to the peritoneum. So he underwent the transarterial embolization for the HCC several times. However, the tumor was recurred. The abdominal CT scan is used to diagnose the fistula, followed by foregut endoscopy. Diagnosing malignant duodenocolonic fistula can be challenging due to its rarity and nonspecific symptoms. He felt frequent regurgitation of food and also vague abdominal pain for a while. HCC was already spread out at the peritoneum. It was not possible to remove the whole area. In this case we treated the malignant fistula using a covered duodenal stent to relieve debilitating vomiting and abdominal pain. It is a less invasive method. We could place the metal stent using the colonoscope. Even after placing the metal stent, his condition was so so. He just got by for a while. Unfortunately he passed away 3 months after placing the metal stent because of the stent migration to the colon.

Publication History

Article published online:
27 March 2025