Duodenocaval fistula: a late complication of retroperitoneal irradiation and vena cava replacement.

Abstract:

: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.

journal_name

Ann Vasc Surg

authors

Perera GB,Wilson SE,Barie PS,Butler JA

doi

10.1007/s10016-003-0097-8

subject

Has Abstract

pub_date

2004-01-01 00:00:00

pages

52-8

issue

1

eissn

0890-5096

issn

1615-5947

pii

S0890-5096(06)61095-9

journal_volume

18

pub_type

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