Abstract 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.

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

Duodenocaval fistula (DCF) is a rare entity which is sparsely described in the literature. Few etiologies have been listed including chemoradiation therapy. Early recognition may reduce the high mortality rate. We describe the case of a 63-year-old woman with a history of stage III ovarian cancer treated with cytoreductive surgery and adjuvant chemotherapy, including bevacizumab, who presented to the hospital because of fresh blood per rectum. One month earlier, the patient was admitted to the intensive care unit because of hemorrhagic shock secondary to a necrotic duodenal ulcer and was treated with cauterization. The patient was stable when discharged home, however, she was readmitted to the hospital because of hematemesis and hematochezia and was again in hemorrhagic shock for which the patient was urgently transfused. An abdominal computerized tomography (CT) angiography demonstrated locules of air within the intrahepatic and infrahepatic inferior vena cava (IVC), as well as evidence of communication with the duodenal lumen, and a thrombus within the IVC. The patient was evaluated by the surgical oncology and vascular teams, who deemed the patient inoperable. Our case describes ovarian malignancy, treated by radiation, leading to duodenitis, with subsequent ulcer formation. The co-administration of bevacizumab delayed gastric healing and promoted ulcer perforation favoring fistula formation.

/pdf/duodenocaval-fistula-a-spontaneous-complication-of-28ttu9nx.pdf

Duodenocaval Fistula: A Spontaneous Complication of Chemoradiation Therapy in Stage III Ovarian Cancer

http://www.jvscit.org/article/S2468428722000892/pdf

Treatment of a duodenal-caval fistula secondary to peptic ulcer disease

A man in his 60s attended emergency for acute-onset abdominal pain and haematemesis. Requiring resuscitation, a CT abdomen/pelvis revealed a primary aortoenteric fistula actively bleeding into the duodenum. His background included a previous severe Q-fever infection and a heavy smoking history. Despite attempts at resuscitation and an emergent surgical attempt at haemostasis, the patient did not survive the massive gastrointestinal haemorrhage.Even in less severe cases, management of aortoenteric fistulas is tricky. Blood cultures and angiographic imaging are important investigations in guiding surgical approach. The pathology tends to have a significant rate of mortality even at tertiary-level vascular surgical centres.

Massive gastrointestinal bleed due to a primary aortoenteric fistula.

Endovascular exclusion of aortoenteric fistula has been described as a bridge to definitive open repair surgery. However, little is known about transposing this technique to treat duodenocaval fistula. We report a case of a 20-year-old man who presented with a duodenocaval fistula arising from a metastatic nonseminomatous germ cell tumor. A staged technique using an initial endovenous exclusion of the fistula permitted stabilization of the patient and completion of his chemotherapy regimen. Subsequently, the stent graft was explanted with concomitant autogenous caval reconstruction, allowing the patient to be cancer free at 1-year follow-up.

Staged surgical treatment of a primary duodenocaval fistula in a patient with metastatic nonseminomatous germ cell tumor

Q fever aortic infection causing an aortoduodenal fistula after endovascular aneurysm repair.

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Staged surgical treatment of a primary duodenocaval fistula in a patient with metastatic nonseminomatous germ cell tumor

Q fever aortic infection causing an aortoduodenal fistula after endovascular aneurysm repair.