Fishbone perforation causing duodenocaval fistula and caval thrombus

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

“…About half of the DFC were traumatic in origin (26, 46.4%), caused by a penetrating abdominal trauma [ 3 ] or the migration of an ingested foreign body (toothpick, chicken or fish bone) [ 4 , 16 , 20 ] or a caval filter, which is one of the most common causes [ 1 , 2 , 9 , 17 , 18 , 25 ]. Such an event is usually a late complication, because the time between caval filter placement and the occurrence of the fistula was on average 6 years (range, 7 days to 11 years) with a mortality mostly found in the ingestion of foreign bodies (four cases) .…”

“…Although 30 (69.6%) of the 56 patients with DCF complained of at least one of these signs, only 25 patients (44.6%) demonstrated both septic- and bleeding-related manifestations. Other presentations were nonspecific abdominal pain [ 9 ], weight loss [ 11 ], fever of unknown origin [ 2 ], diarrhea [ 13 ], hemorrhagic shock [ 6 ], respiratory distress [ 20 ] and stroke secondary to cerebral air embolism [ 7 ] after gastroduodenoscopy. Because symptoms are so nonspecific, diagnosis is mainly based on the results of radiologic studies, and the abdominal CT is the most sensitive and specific exam.…”