A case of pancreaticoduodenum combined with right hemicolectomy for the treatment of a high-risk patient with duodenocolic fistula 1.Patient’s condition: the patient, female, 48 years old, was anemic and lethargic with diarrhea for more than 3 months. 3 months ago, the patient presented with lethargy and anemia and diarrhea, and was found to have colon cancer that invaded the duodenum after examination. In addition to the anemia and lethargy related to tumor consumption, it was also found that the tumor originated in the colon, and because of the invasion of duodenum, which led to duodenocolic fistula, the food consumed was directly discharged from the duodenum (the beginning of small intestine) into the large intestine through the anus, and the food consumed was basically not digested and absorbed, and coupled with the consumption of the tumor of a huge size, the patient suffered from severe malnutrition. 2. After the consultation with the general surgery experts in the local hospital (a tertiary care hospital), the surgery was considered to be high-risk and difficult, and it was difficult to perform radical resection, so the surgery was abandoned. The patient was transferred from surgery to medical oncology for chemotherapy. When the medical oncologist informed the patient’s family that due to the large size of the tumor, poor physical condition, the tumor had not been resected, the effect of chemotherapy was poor, and the prognosis of survival was very short, the whole family was plunged into pain and despair. 3. The patient’s preoperative abdominal CT, as shown in the figure: 4. Preoperative examination: cardiopulmonary function is normal. The patient’s physical condition was poor and she was severely malnourished. The deep vein catheter that was left in the local hospital led to thrombosis in the right upper limb and extended the subclavian vein and superficial external jugular vein. 5. Relevant specialists’ consultation opinion: it was thought that surgery was possible, but the risk was extremely high. Because 1. pancreaticoduodenal combined right hemicolectomy is complicated and difficult. 2. thrombus dislodgement may occur easily and lead to death. 6. Intra-departmental discussion: high risk, palliative surgery is recommended, not radical surgery. Or short circuit to lift the internal fistula can be. 7. Patient and family opinion: resolutely request surgery, understand the risk of surgery. 8. My opinion: 1. According to the imaging suggests that radical resection can be achieved. 2. Although the patient’s physical condition is poor, but young, the function of each organ resistance to traumatic injury is strong. 3. Vascular surgery experts believe that although the risk of surgery is high, but it is not a contraindication to surgery. 4. Surgery as far as possible, the operation should be fast, gentle, according to the salvage surgery treatment. 5. If not surgery, there is no other way. Poor results of chemotherapy and other treatments are treated as abandonment of treatment. If the tumor continues to develop, the chance of radical treatment may be missed.6. Patients and their families fully understand the risks of surgery. The final treatment opinion of this treatment group: We strongly recommend radical tumor resection surgery. 7. 9. Surgical procedure: the operation went smoothly with little bleeding and the patient was stable during the operation. Surgical procedure: pancreaticoduodenum + right hemicolectomy. Surgical time: 3 hours and 50 minutes. 10. Postoperative pathology: colon adenocarcinoma invaded the duodenum, with clean margins and no lymph node metastasis. 11. Postoperative abdominal CT: 8 days after surgery.11 Patient’s postoperative recovery: postoperative recovery was smooth, no pancreatic or biliary leakage. She was discharged 12 days after surgery. Chemotherapy with capecitabine was given.