Gastroduodenal artery‐duodenal fistula: A complication of continuous floxuridine (FUDR) infusion into the gastroduodenal artery

Abstract

This case report describes a patient who for 31 months has received regional intrahepatic chemotherapy from a continuous infusion pump and who developed a gastroduodenal artery-duodenal fistula, a previously unreported complication of regional infusion therapy. The patient presented with signs and symptoms of upper gastrointestinal bleeding. The clinical evaluation and management are described. An angiogram was performed through the auxillary septum to identify the source of bleeding. The possible etiologic factors in this case are discussed. We believe that this complication will continue to be rare, but health care providers should be aware of its presentation and its preferred method of evaluation and management.

Adjuvant hepatic arterial infusion after curative resection of colorectal liver metastases using removable intra‐arterial catheters with shape‐memory alloy

“…It is preferable to remove the catheter and reservoir after limited time of adjuvant chemotherapy if the patients seldom need the therapeutic system again in the future. Indwelling catheters in the hepatic artery for a long time may cause complications including arteritis, occlusion, stenosis, or thrombosis of the artery and infection [25][26][27][28], and patient's quality of life is also disturbed.…”

“…Although three patients had to interrupt the HAI chemotherapy for a week or two, the symptoms were not serious and scheduled course of the adjuvant chemotherapy was completed in all patients. It has been reported that long-term HAI of fluoropyrimidines may cause serious complications such as hepatitis, liver necrosis, cholangitis [25][26][27][28][32][33][34]. However, within the limited period of infusion and under careful management, adverse events of HAI chemotherapy are even rare compared with the systemic chemotherapy [6,8,35].…”

Differential Device Performances for Hepatic Arterial Chemotherapy: A Technical Report on Totally Implantable Pumps and Ports for Both Continuous and Bolus Infusion

“…This could be due to both a possible underestimation of symptoms and a fairly low dose intensity in patients treated with FUdR [6]. Various events inducing system failure have been reported [6,7,[26][27][28][29][30][31], whose greater and earlier incidence in patients with ports seems to be related to the limits of the system when used for long-term CI. Median duration of ports for CI, however, appears marginally suitable to clinical requirements.…”

Interventional management of gastroduodenal lesions complicating intra-arterial hepatic chemotherapy

“…These complications seem to be more frequent with 5-FU although they can be observed with other drugs [9] suggesting a predominantly toxic origin. Mucosal gastroduodenal ischemia has been related to the ligature or embolization of arterial supply and to the direct traumatic effect of the catheter and sutures in the intestinal wall [10,16]. Stress associated with the treatment may also play a role [10].…”