Duodenocaval fistula after treatment with bevacizumab

Curell, Anna; Gómez-Jurado, María José; Sánchez, José Luis; Espín, Eloy

doi:10.1016/j.medcle.2019.04.019

Cited by 3 publications

(6 citation statements)

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“…But our case is different as it is associated with the administration of a biological drug such as bevacizumab. Three other similar cases are reported in the literature [ 22–24 ]. All of them were women with an average age of 64.7 years (range 58–69 years) with a clinical history of ovarian or cervical cancer who underwent surgery and subsequently radio and chemotherapy with the help of bevacizumab.…”

Section: Discussionmentioning

confidence: 72%

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

Giordano,

Moroni,

Gosmar

et al. 2023

Journal of Surgical Case Reports

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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.

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Section: Discussionmentioning

confidence: 72%

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

Giordano,

Moroni,

Gosmar

et al. 2023

Journal of Surgical Case Reports

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“…4,8 While 4 reported cases associate DCF with the antiangiogenic bevacizumab, this case marks the first associated with lenvatinib. 4,[9][10][11] These 2 drugs share similar mechanisms, with bevacizumab directly inhibiting VEGF and lenvatinib indirectly inhibiting VEGF through its tyrosine kinase receptor. The SE-LECT trial demonstrated 1.5% of patients on lenvatinib developed a gastrointestinal fistula or perforation.…”

Section: Discussionmentioning

confidence: 99%

“…12 The proposed mechanism includes platelet-endothelial cell homeostasis disruption with resultant submucosal inflammation/ulceration, diminished healing capacity, and thrombosis and/or vasoconstriction-related mesenteric ischemia. 11 Lenvatinib was continued for 2 weeks before being identified as a potential contributing factor. This case highlights the need for a high index of suspicion for DCF and consideration for preventative strategies in at-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Duodenocaval Fistula: Unmasking the Rare Culprit of Gastrointestinal Hemorrhage

Fiedler,

Dhindsa,

Singh

2024

ACG Case Rep J

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Duodenocaval fistula is an extremely rare and life-threatening cause of gastrointestinal hemorrhage and septicemia. Diagnosing this condition is challenging due to its nonspecific symptoms, leading to significant delays in diagnosis and contributing to its remarkably high mortality rate. We present a unique case of duodenocaval fistula associated with prior radiation, peptic ulcer disease, and antiangiogenic cancer therapy, nearly resulting in the death of a young patient.

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“…A DCF can be created by a foreign body such as toothpick, fishbone, or penetrating abdominal injury [ 3 - 6 ]. Other cases have reported that it is secondary to peptic ulcer disease eroding the duodenal wall and building communication with the adjacent IVC [ 1 , 7 ]. Also, atraumatic DCF has been described following chemoradiation or radiotherapy alone in retroperitoneal tumors.…”

Section: Discussionmentioning

confidence: 99%

“…Bevacizumab, an antiangiogenic agent, has also been implicated as it promotes mucosal ulceration and delays its healing, facilitating fistula formation in the gastrointestinal tract [ 8 , 9 ]. Clinical presentation varies from simple abdominal pain, vomiting, and diarrhea to more severe manifestations such as fever, sepsis, and most commonly gastrointestinal bleed [ 4 , 7 ]. This entity can be complicated by bacteremia and fungemia [ 2 , 3 , 6 , 8 ], vena cava thrombus [ 1 , 5 , 6 ], and rarely pulmonary embolism [ 6 ]; the most dreaded complication is hemorrhagic shock [ 1 ], as noted in our case, and two similar ones illustrated by Perera et al.…”

Section: Discussionmentioning

confidence: 99%

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

Assaad¹,

Hamadi²,

Gharib³

et al. 2022

Cureus

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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.

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Duodenocaval fistula after treatment with bevacizumab

Cited by 3 publications

References 0 publications

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

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

Duodenocaval Fistula: Unmasking the Rare Culprit of Gastrointestinal Hemorrhage

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

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