Gastrocolic fistulas (GCFs) are rare gastrointestinal abnormalities characterized by an abnormal connection between the stomach and colon, with reported global incidence of 0.2–0.6%. Symptoms are nonspecific, and diagnosis is often delayed or incidental via imaging or endoscopy. Cadaveric descriptions remain limited but provide a unique opportunity to explore gross anatomy of GCFs. This case anatomically characterizes a cadaveric GCF to evaluate potential etiologies within the context of existing clinical literature. A 91-year-old female cadaver with causes of death including congestive heart failure, pneumonia, and failure to thrive underwent routine gross dissection. A fistulous tract between the greater curvature of the stomach and transverse colon was documented with calibrated gross photography and measurement. A focused literature review of GCF etiologies was performed. A mature lumenal fistula measuring 32.93 mm long and 5.44 mm wide connected the gastric greater curvature to the left colic flexure, traversing dense fibrotic tissue adherent to the gastrocolic ligament. Considerable sessile gastric polyps were identified on the internal gastric wall. No evidence of inflammation, abscess, ischemic injury, or prior surgery was identified in surrounding structures. Dense fibrosis and mature tract suggest a chronic process. Considerations include malignancy, chronic inflammation (ulcer disease, Crohn’s disease), and surgery. Malignancy is favored given advanced age, failure to thrive, and diffuse gastric polyposis. Histologic evaluation would distinguish malignancy from benign inflammatory process. This report enhances GCF literature by relating gross anatomy to established clinical patterns and emphasizes the consideration of GCF in patients with unexplained metabolic/nutritional decline.
