Gastrocolic Fistula Secondary to Gastric Squamous Cell Carcinoma

Background: Gastric carcinoma is relatively rare in the United States with gastric squamous cell carcinoma (GSCC) comprising only 0.2-2%1 of all gastric cancers. Gastrocolic fistulas (GCF) are also rare with an incidence of 0.3-0.4%2. The majority of GCF originate from malignancies in the colon3. This is the first case in medical literature highlighting the intersection of these two distinct and rare digestive diseases. Case information: This is a case of a 77-year-old African American female who initially presented with intractable nausea and vomiting, a weight loss of 28 pounds and worsening constipation. She denied worsening abdominal pain, fever, chills, and diarrhea. Upper endoscopy revealed a large gastric mass with severe gastric stasis containing feculent material, suggesting a GCF. An enema study demonstrated a fistulous communication of the proximal descending colon and stomach. Exhaustive staining identified poorly differentiated SCC. There was no evidence of primary esophageal SCC on two separate endoscopies. Complete work up for SCC outside of the stomach was negative. Due to age, co-morbidities, and malnutrition, the patient was deemed a poor surgical candidate and was discharged home on hospice. Conclusion: This case is presented to alert providers of the possible correlation of these two rare diseases. Early diagnosis of one of these two diseases should lead future providers to consider the other and explore a possible relation between them.