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Duodenocaval Fistula: A Late Complication of Retroperitoneal Irradiation and Vena Cava Replacement

  • Papers Presented to the Southern California Vascular Surgical Society
  • Published:
Annals of Vascular Surgery

Abstract

Duodenocaval fistula (DCF), an unusual pathology, is associated with a 40% mortality rate in the 36 patients previously reported. Although migrating or ingested foreign bodies, trauma, and peptic ulcer disease are often described etiologies, 11 patients have been described who developed DCF after resection of retroperitoneal tumors, 9 of whom also had postoperative radiotherapy. We report two patients who developed DCF after resection of retroperitoneal tumors followed by radiation therapy. The first patient, a 56-year-old female, presented with upper gastrointestinal hemorrhage requiring transfusion caused by a duodenoprosthetic caval fistula 7 years after successful resection of a retroperitoneal leiomyosarcoma and replacement of the inferior vena cava followed by radiation and chemotherapy. The second patient, a 37-year-old male who had previously undergone resection of a retroperitoneal sarcoma followed by external radiotherapy, developed massive upper and lower gastrointestinal bleeding secondary to a duodenocaval fistula. The etiology, diagnosis, and treatment of DCF are analyzed with an emphasis on DCF following resection and irradiation of retroperitoneal tumors. In most patients, “spontaneous” DCF have occurred as a late complication of high-dose radiation for carcinoma of the right kidney or retroperitoneal structures.

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Authors and Affiliations

  1. Department of Surgery, University of California, Irvine Medical Center, Orange CA, USA

    Ganesha B. Perera MD & Samuel E. Wilson MD

  2. Division of Critical Care and Trauma, Department of Surgery and Public Health, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA

    Philip S. Barie MD

  3. Division of Surgical Oncology, Department of Surgery, University of California, Irvine Medical Center, Orange CA, USA

    John A. Butler MD

Authors
  1. Ganesha B. Perera MD
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  2. Samuel E. Wilson MD
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  3. Philip S. Barie MD
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  4. John A. Butler MD
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Corresponding author

Correspondence to Samuel E. Wilson MD.

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Perera, G.B., Wilson, S.E., Barie, P.S. et al. Duodenocaval Fistula: A Late Complication of Retroperitoneal Irradiation and Vena Cava Replacement. Ann Vasc Surg 18, 52–58 (2004). https://doi.org/10.1007/s10016-003-0097-8

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  • DOI: https://doi.org/10.1007/s10016-003-0097-8

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