A fistulous communication between the stomach and the transverse colon occurs in about 25 per cent, of all cases of gastric carcinoma, and is most frequent when the primary growth involves the great curvature (vide p. 49). This complication only ensues at an advanced stage of the complaint, and its symptoms vary according to the size of the aperture between the two viscera. As a rule, the rupture of the intestinal wall is not accompanied by any noticeable symptoms, but occasionally the patient experiences a sudden and severe pain in the abdomen, which may be accompanied by retching, shivering, or diarrhoea.
Faecal vomiting is chiefly observed when the fistula is of large size and the pylorus is free from disease, since the establishment of a secondary opening in a stomach which is greatly dilated from pyloric stenosis usually relieves the previous vomiting, by permitting the contents of the viscus to escape into the bowel. On the other hand, a small or valvular opening in the colon may only be accompanied by a faecal odour in the ejecta or an intensely foul taste in the mouth. The passage of undigested food immediately after it has been swallowed (lienteric diarrhoea) is another important indication of a gastrocolic fistula, and usually replaces the periodic vomiting from which the patient previously suffered. In every case the intestinal complication is accompanied by a rapid increase of the debility and cachexia, and death usually ensues within a fortnight of its development.
A gastro-colic fistula is seldom difficult to recognise when accompanied by faecal vomiting or lienteric diarrhoea, but when it merely produces an unpleasant odour in the breath or the vomit it is liable to be overlooked. Beeves was the first to notice that enemata are often vomited if much force has been employed in their administration ; and this fact is of considerable value in diagnosis, since the rejection of a coloured fluid soon after it has been injected into the bowel necessarily indicates the existence of an abnormal communication between the colon and the stomach. In one case v. Ziemssen was able to detect the fistula by observing that when gas was introduced into the rectum it escaped into the stomach without distending the colon. According to Levinstein, loud gurgling sounds may be heard over the site of the fistula upon auscultation of the abdomen. The formation of a fistula between the stomach and the small intestine can only be surmised by the sudden subsidence of vomiting and other symptoms of dilatation of the stomach, and their replacement bv diarrhoea.