Korean J Gastroenterol.  2014 Feb;63(2):125-128. 10.4166/kjg.2014.63.2.125.

A Case of Colonic Pseudoobstruction Related to Bacterial Overgrowth Due to a Sigmoidocecal Fistula

• Chung KM
• Lim SU
• Hong HJ
• Park SY
• Park CH
• Kim HS
• Choi SK
• Rew JS

• KMID: 1730920
• DOI: http://doi.org/10.4166/kjg.2014.63.2.125

Abstract

Colocolic fistulas are usually a complication of an inflammatory or neoplastic process. Development of these abnormal bowel communications may lead to bacterial overgrowth. We report on a 71-year-old man with a one-year history of recurrent abdominal distension and irregular bowel habits. Abdominal X-rays and computed tomography showed multiple air-fluid levels and loops of distended bowel without evidence of mechanical obstruction or diverticulitis. Colonoscopy showed a fistulous tract between the sigmoid colon and cecum. Results of a lactulose breath test showed high fasting breath CH4 levels, which were thought to be the result of intestinal bacterial overgrowth. The patient was diagnosed with a colonic pseudo-obstruction associated with bacterial overgrowth due to a sigmoidocecal fistula. We recommended surgical correction of the sigmoidocecal fistula; however, the patient requested medical treatment. After antibiotic therapy, the patient still had mild symptoms but no acute exacerbations.

Keyword

Colonic pseudo-obstruction; Intestinal fistula; Diverticulum; Colon

MeSH Terms

Aged
Anti-Bacterial Agents/therapeutic use
Breath Tests
Colonic Pseudo-Obstruction/*diagnosis/etiology
Colonoscopy
Humans
Intestinal Fistula/*diagnosis/drug therapy/microbiology
Male
Methane/chemistry/metabolism
Tomography, X-Ray Computed
Anti-Bacterial Agents
Methane

Figure

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  Fig. 1. Plain abdominal radiography in erect position. Distended intestine, especially the large intestine, and multiple air-fluid levels are seen.

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  Fig. 2. Colonoscopic findings. White numbers corresponding to the insertion lengths of the colonoscope could be seen through the fistulous opening located in the cecum. The appendiceal orifice was normal.

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  Fig. 3. Barium enema study. A definitive connection of the sigmoid colon and cecum is confirmed (white arrows).

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  Fig. 4. Lactulose hydrogen breath test. (A) Before treatment, increased methane gas is estimated using a gas chromatograph. (B) After treatment, fasting breath CH4 concentration levels decline markedly but remain above the normal range. f, fraction.

Reference

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