NSAID-Induced Giant Gastric Ulcer Complicated by Massive Gastrocolic Fistula: A Case Report and Comprehensive Review of Contemporary Management Strategies

Background Gastrocolic fistula (GCF) represents a rare but life-threatening complication of peptic ulcer disease, with evolving etiology from predominantly benign to malignant causes over recent decades. NSAID-induced gastrocolic fistulas, while uncommon, pose significant diagnostic and therapeutic challenges in contemporary practice. Case Presentation: We present a 70-year-old female with chronic pain syndrome who developed a massive (4.5 cm) gastrocolic fistula secondary to chronic high-dose NSAID overuse (aspirin 3000 mg/day and ibuprofen 1000 mg/day for > 2 years). Clinical presentation included severe iron-deficiency anemia (hemoglobin 6.0 g/dL), melena, and constitutional symptoms. Comprehensive evaluation confirmed benign etiology through endoscopic visualization, histopathological examination, and cross-sectional imaging. Management and Outcomes: The patient underwent successful robotic-assisted laparoscopic surgery including distal gastrectomy, right hemicolectomy, and Roux-en-Y reconstruction. Postoperative course was uncomplicated with complete symptom resolution and excellent functional outcomes at 12-month follow-up. Literature Review: Systematic analysis of 127 published cases (2000–2024) reveals evolving epidemiology, diagnostic approaches, and treatment modalities for gastrocolic fistula. Contemporary management emphasizes multidisciplinary evaluation, advanced imaging techniques, and minimally invasive surgical approaches when feasible. Conclusions This case demonstrates successful management of a rare NSAID-induced complication using modern surgical techniques. The comprehensive literature review provides evidence-based recommendations for diagnosis, treatment selection, and prevention strategies in the contemporary management of gastrocolic fistula.