Spontaneous Duodenocaval Fistula During Chemo-Radiotherapy

Tenezaca-Sari, Xavier; García-Reyes, Marvin

doi:10.1016/j.ejvs.2019.07.002

Cited by 4 publications

(3 citation statements)

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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%

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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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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“…5 Tenezaca-Sari et al reported a case of a 69-year-old woman with advanced cervical squamous cell carcinoma developed a DCF after receiving palliative chemoradiation. 6 Perera et al reported 2 cases of DCFs formed after resection of retroperitoneal tumors followed by radiation therapy, noting that spontaneous formation of these fistulas mostly occurred as late complications of high-dose radiation to retroperitoneal structures. 7 To our knowledge, this is the first reported case of complex 3-way fistulas between the arterial, venous, and enteric system; specifically, iliac artery, IVC, and duodenum.…”

Section: Discussionmentioning

confidence: 99%

Iliac Artery–Inferior Vena Cava–Duodenal Fistula: An Unusual Cause of Massive Gastrointestinal Bleeding

Karna,

Jagdish,

Mohy-Ud-Din

et al. 2023

ACG Case Rep J

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An arteriovenous-enteric fistula is a 3-way connection between the vascular and enteric system and associated with high mortality. We describe a case of iliac artery–inferior vena cava–duodenal fistula in a young female with a retroperitoneal mass presenting with sepsis and hemorrhagic shock with a catastrophic clinical course. These fistulas can be missed on endoscopy/colonoscopy and are usually diagnosed on computed tomography angiogram of the abdomen. Complex vasculoenteric fistula should be among differentials in patients presenting with gastrointestinal bleeding, especially with a history of malignancy, radiation, foreign bodies, and trauma. The management is complex and should involve a multidisciplinary approach involving vascular surgery, intervention radiology, and gastroenterologist.

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“…Also, atraumatic DCF has been described following chemoradiation or radiotherapy alone in retroperitoneal tumors. 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 ].…”

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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Spontaneous Duodenocaval Fistula During Chemo-Radiotherapy

Cited by 4 publications

References 0 publications

Duodenocaval Fistula: Unmasking the Rare Culprit of Gastrointestinal Hemorrhage

Duodenocaval Fistula: Unmasking the Rare Culprit of Gastrointestinal Hemorrhage

Iliac Artery–Inferior Vena Cava–Duodenal Fistula: An Unusual Cause of Massive Gastrointestinal Bleeding

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

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