Primäre aortoduodenale Fistel als Spätkomplikation nach paraaortaler Radiatio Ein Fallbericht

Abstract

Primary aortoenteric fistulae (AEFs) are rare vascular entities. More than 75% of primary AEFs involve the duodenum, with the overwhelming majority located in the third or fourth portion. Atherosclerosis, leading to formation of an aortic aneurysm, remains the most common etiology, accounting for more than 3/4 of the cases reported. Primary aortoenteric fistulae following radiotherapy are rare. The case of a 49-year-old man with aortoduodenal fistula 22 years after para-aortic radiation is presented. In November 1997, the patient suddenly developed hematemesis and melena. Endoscopy suggested the presence of an ulcus but no definitive bleeding source could be seen. Bleeding stopped spontaneously. Six hours later he developed massive hematemesis and was transferred to our department. An emergency operation was performed. We found an aorto-duodenal fistula in the third portion of the duodenum without an aortic aneurysm. We directly sutured the aortic wall laceration and resected the third and fourth part of the duodenum. Histology revealed typical signs of radiation damage. The patient is alive and well 2 years after surgery. To our knowledge, this is the sixth case of a primary aorto-duodenal fistula following radiotherapy ever to be reported in world literature.

Primary Aorto-Duodenal Fistula as a Late Complication of Radiotherapy: Report of a Case and Review of the Literature

“…An ulcer was also present at laparotomy in case no. 7 [25]. In our case the evidence was conflicting.…”

“…In fact an ulcer appeared to be at the origin of the fistula in cases no. 3, 5 and 6 [15, 25, 30]. In the first case a 1.3 cm ulcer penetrating through the duodenal wall was discovered.…”

“…Uncommon causes of PADF include carcinoma of the pancreas [14], biliary stones [15], trauma [16], ingested foreign bodies [17], peptic ulcer disease [18], benign cysts [19] and duodenal diverticular disease [20]. Four cases of idiopathic PADF are reported [21, 22, 23, 24], while seven cases of PADF following abdominal radiotherapy for malignancy are described in the medical literature [25, 26, 27, 28, 29, 30, 31]. We report a case of PADF developfing 25 years after surgery and radiotherapy and successfully treated at our institution.…”

Sentinel Bleeding as a Sign of Gastroaortic Fistula Formation after Oesophageal Surgery

“…It is possible that radiation caused relative ischemia of the oesophagus causing partial destruction of the mucosal barrier. Histological studies have shown that mainly the submucosal layer is affected by the radiation, resulting in teleangiectasia, fibrosis, and neovascularization [ 8 ]. Besides causing damage to the epithelium of the intestinal tract, damage to the arterial wall could be expected following radiotherapy.…”

Unusual site for primary arterio-enteric fistula resulting in massive upper gastrointestinal bleeding – A case report on presentation and management

“…It is a rare life-threatening cause for massive upper gastrointestinal bleeding and is fatal unless treated promptly. It involves the duodenum in more than 75% of cases, mostly the third or fourth duodenal segments [ 2 ].…”