Local recurrence of renal cell carcinoma causing duodenal-inferior vena caval fistula: case report and review of the literature

Duodenocaval fistula after bevacizumab therapy: case presentation and complete overview of the literature

Duodenocaval fistula (DCF) is a very rare condition and is associated with a 41.1% of mortality rate. Although ingested foreign bodies, peptic ulcer disease and radiotherapy are often the etiologies described, only three patients have been described who developed DCF after bevacizumab therapy. We report a case of a 58-year-old woman with a history of ovarian neoplasia and subsequent surgical treatments, adjuvant radiotherapy and chemotherapy with bevacizumab with the appearance of a spontaneous DCF after 6 months at the end of this therapy. The multidisciplinary approach between oncologist and vascular surgeon together with the support of the anesthesiology team allowed the DFC to be treated surgically through the suture of the inferior vena cava and the duodenal breach. The patient was discharged on the 14th postoperative day and we found no postoperative morbidities both immediately and after 30 and 60 days.

Gastro-caval fistula after distal esophageal resection: a case report and review of the literature

Peptic ulceration with fistula formation into the inferior vena cava is rare, difficult to diagnose, and associated with high mortality. The nonspecific signs and symptoms make diagnosis challenging, delaying optimal treatment. Although there have been reports on duodeno-caval fistulas, gastric communication with the inferior vena cava is very rare. We report the second case of a fatal gastro-caval fistula and performed a review of the literature on entero-caval fistulas to emphasize the importance of early suspicion and to understand the most common presentation, as well as the best diagnostic and treatment modalities of this rare pathology.

Endovascular stent reconstruction of the inferior vena cava complicated by duodenocaval fistula

A patient with retroperitoneal metastatic uterine adenocarcinoma resulting in symptomatic occlusion of the inferior vena cava underwent palliative endovascular stent reconstruction and subsequent radiation therapy. She then developed sepsis and massive lower gastrointestinal bleeding. Computed tomography (CT) and cavography demonstrated a fistulous communication between the duodenum and the stented segment of inferior vena cava. Deployment of endovascular stent graft devices successfully occluded the fistulous communication and resulted in clinical improvement.

Fistula between the Jejunum and the Inferior Vena Cava after Esophagojejunal Anastomosis

Fistulas between the luminal gastrointestinal tract and vascular structures can result from a variety of etiologies. While there have been reports of fistulas between the inferior vena cava and the duodenum, we report the first case to our knowledge of a fistula between the jejunum and the inferior vena cava after esophagojejunal anastomosis for recurrent esophageal adenocarcinoma.

Radiological diagnosis of duodenocaval fistula: A case report and literature review

Duodenocaval fistula (DCF) is an uncommon but lethal clinical entity. The high mortality has been attributed to the difficulty of diagnosis before attempts at definitive therapy. In this case report, we describe a patient with a series of computed tomography (CT) examinations over a 2-mo period in hospital. A low-density air bubble appeared in the inferior vena cava (IVC) on the second day in hospital and became clear on day 19, and gradually enlarged. Magnetic resonance imaging (MRI) also clearly demonstrated a high-signal enteric contrast medium or thrombus and signal-void air bubbles in the IVC. However, cavography did not show the filling defect. We suggest that noninvasive CT and MRI should be chosen as a first-line investigation, and IVC, including the surrounding structures, should be carefully reviewed on images if DCF is clinically considered.

Duodenocaval Fistula: A Late Complication of Retroperitoneal Irradiation and Vena Cava Replacement

Duodenocaval fistula (DCF), an unusual pathology, is associated with a 40% mortality rate in the 36 patients previously reported. Although migrating or ingested foreign bodies, trauma, and peptic ulcer disease are often described etiologies, 11 patients have been described who developed DCF after resection of retroperitoneal tumors, 9 of whom also had postoperative radiotherapy. We report two patients who developed DCF after resection of retroperitoneal tumors followed by radiation therapy. The first patient, a 56-year-old female, presented with upper gastrointestinal hemorrhage requiring transfusion caused by a duodenoprosthetic caval fistula 7 years after successful resection of a retroperitoneal leiomyosarcoma and replacement of the inferior vena cava followed by radiation and chemotherapy. The second patient, a 37-year-old male who had previously undergone resection of a retroperitoneal sarcoma followed by external radiotherapy, developed massive upper and lower gastrointestinal bleeding secondary to a duodenocaval fistula. The etiology, diagnosis, and treatment of DCF are analyzed with an emphasis on DCF following resection and irradiation of retroperitoneal tumors. In most patients, "spontaneous" DCF have occurred as a late complication of high-dose radiation for carcinoma of the right kidney or retroperitoneal structures.

Duodenocaval fistula: a life-threatening condition of various origins

We report on two cases of duodenocaval fistula. The first patient, a 73-year-old man, had sepsis and occult digestive bleeding. We diagnosed a fistula that resulted from a right nephrectomy and subsequent radiotherapy for a urothelial tumor 20 months earlier. The second patient, a 60-year-old woman, complained of right abdominal pain. A duodenocaval fistula that was caused by duodenal perforation by a migrating caval filter placed 10 years earlier was revealed by means of endoscopy. Both patients had a successful operation to treat the condition. An extensive review of the literature disclosed 35 other cases and identified two factors of good prognosis: duodenocaval fistulas caused by migrating caval filters and early surgery.