Duodenocaval Fistula in a Patient with Inferior Vena Cava Leiomyosarcoma Treated by Surgical Resection and Caval Polytetrafluoroethylene Prosthesis

A Case of Duodenocaval Fistula in the Setting of Respiratory Failure Initially Confused for Transfusion-Related Acute Lung Injury

Background

A duodenocaval fistula is seen when a connection exists between the duodenum and the inferior vena cava. It is a rare entity that presents a diagnostic challenge due to its nonspecific presenting symptoms and often is found only during a laparotomy or autopsy.

Case Presentation

A 37-year-old man initially presented to the hospital for melena but went into cardiac arrest before undergoing an esophagogastroduodenoscopy. Unfortunately, a duodenocaval fistula was only found during the autopsy.

Conclusions

Duodenocaval fistula is a diagnostic challenge as it may present with nonspecific findings concerning for other etiologies. We want to highlight that although rare, duodenocaval fistula should be considered for patients who present with gastrointestinal bleeding and hypoxic respiratory failure.

Gastro-caval fistula after distal esophageal resection: a case report and review of the literature

Peptic ulceration with fistula formation into the inferior vena cava is rare, difficult to diagnose, and associated with high mortality. The nonspecific signs and symptoms make diagnosis challenging, delaying optimal treatment. Although there have been reports on duodeno-caval fistulas, gastric communication with the inferior vena cava is very rare. We report the second case of a fatal gastro-caval fistula and performed a review of the literature on entero-caval fistulas to emphasize the importance of early suspicion and to understand the most common presentation, as well as the best diagnostic and treatment modalities of this rare pathology.

Staged surgical treatment of a primary duodenocaval fistula in a patient with metastatic nonseminomatous germ cell tumor

Endovascular exclusion of aortoenteric fistula has been described as a bridge to definitive open repair surgery. However, little is known about transposing this technique to treat duodenocaval fistula. We report a case of a 20-year-old man who presented with a duodenocaval fistula arising from a metastatic nonseminomatous germ cell tumor. A staged technique using an initial endovenous exclusion of the fistula permitted stabilization of the patient and completion of his chemotherapy regimen. Subsequently, the stent graft was explanted with concomitant autogenous caval reconstruction, allowing the patient to be cancer free at 1-year follow-up.

Aortoenteric and Enterocaval Fistulas Secondary to a Duodenal Erosion Caused by a Prosthetic Vascular Graft

Aortoenteric and enterocaval fistulas represent uncommon complications following vascular surgery. These typically occur secondary to intestinal wall erosion by the prosthetic grafts and materials, and it is associated with regional inflammation and infection. We herein present a patient who developed both of these rare complications caused by a polytetrafluroethylene inferior vena cava (IVC) graft a year after the resection of a rare metastatic Sertoli-Leydig retroperitoneal tumor and concomitant aortocaval reconstruction. The patient presented with herald gastrointestinal bleeding and gram-negative bacteremia; and a duodenotomy, graft removal followed by IVC ligation and repeat right aortoiliac reconstruction were performed. The patient recovered well and following the appropriate postoperative care he was discharged 6 days after surgery without any further vascular or gastrointestinal complications and with neoadyuvant chemotherapy.

Primary Leiomyosarcoma in the Inferior Vena Cava Extended to the Right Atrium: A Case Report and Review of the Literature

A 38-year-old woman had developed an abdominal distention, lower extremity edema, and dyspnea. Imaging examination revealed a large mass in the right atrium which was connected to lesions within the inferior vena cava. Although complete resection of the mass was not possible, partial surgical tumor resection was performed to avoid pulmonary embolization and circulatory collapse. Leiomyosarcoma was diagnosed histologically, and chemotherapy (doxorubicin) followed by radiotherapy was started. By reviewing papers published in the past 10 years that included 322 patients, we also discuss the clinical presentations and prognosis of leiomyosarcoma in the inferior vena cava.