The complication of gastro-enteric fistulisation in neutropenic enterocolitis secondary to aplastic anaemia.

We report the case of a 27-month-old male with an unusual complication of aplastic anaemia and neutropenic enterocolitis. He suffered persistent neutropaenic sepsis and clinical deterioration forced the strategy of matched sibling haematopoietic stem cell transplantation. With engraftment and clinical recovery post-transplant, enteral feeding was re-established. Despite continued improvement the child began to vomit faeculent stomach content. Barium swallow showed gastro-colic and gastro-enteric fistulisation with contrast passing directly from stomach into descending colon and directly into jejunum. Laparotomy confirmed complex fistulae between the gastric body, the splenic flexure of the colon and the jejunum. The diagnosis and management of abdominal pathology secondary to severe pancytopaenia is challenging. Often the patient does not manifest the usual signs of acute abdominal pathology, making the decision to operate and the timing of surgery difficult. Counfounding this is the danger of performing surgery in a pancytopaenic patient. Our case illustrates these challenges and reports the unanticipated finding of a complex gastro-colic fistula.