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Giordano A, Moroni F, Gosmar A, Passagnoli F, Jeong J, Menici F, Baraghini M, Mirasolo VM, Campiglia L, Michelagnoli S, Cantafio S. Duodenocaval fistula after bevacizumab therapy: case presentation and complete overview of the literature. J Surg Case Rep 2023; 2023:rjad329. [PMID: 37309550 PMCID: PMC10257793 DOI: 10.1093/jscr/rjad329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023] Open
Abstract
Duodenocaval fistula (DCF) is a very rare condition and is associated with a 41.1% of mortality rate. Although ingested foreign bodies, peptic ulcer disease and radiotherapy are often the etiologies described, only three patients have been described who developed DCF after bevacizumab therapy. We report a case of a 58-year-old woman with a history of ovarian neoplasia and subsequent surgical treatments, adjuvant radiotherapy and chemotherapy with bevacizumab with the appearance of a spontaneous DCF after 6 months at the end of this therapy. The multidisciplinary approach between oncologist and vascular surgeon together with the support of the anesthesiology team allowed the DFC to be treated surgically through the suture of the inferior vena cava and the duodenal breach. The patient was discharged on the 14th postoperative day and we found no postoperative morbidities both immediately and after 30 and 60 days.
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Affiliation(s)
- Alessio Giordano
- Correspondence address. Surgery Department, Santo Stefano Hospital, ASL Toscana Centro, via di Suor Niccolina 20, 59100 Prato, Italy. Tel: +393289221689; E-mail
| | - Francesco Moroni
- Surgery Department, Santo Stefano Hospital, ASL Toscana Centro, Prato, Italy
| | - Alessandra Gosmar
- Surgery Department, Santo Stefano Hospital, ASL Toscana Centro, Prato, Italy
| | - Federico Passagnoli
- Surgery Department, Santo Stefano Hospital, ASL Toscana Centro, Prato, Italy
| | - Juhye Jeong
- Surgery Department, Santo Stefano Hospital, ASL Toscana Centro, Prato, Italy
| | - Francesco Menici
- Surgery Department, Santo Stefano Hospital, ASL Toscana Centro, Prato, Italy
| | - Maddalena Baraghini
- Surgery Department, Santo Stefano Hospital, ASL Toscana Centro, Prato, Italy
| | - Vita M Mirasolo
- Surgery Department, Santo Stefano Hospital, ASL Toscana Centro, Prato, Italy
| | - Laura Campiglia
- Intensive Care Unit, Santo Stefano Hospital, ASL Toscana Centro, Prato, Italy
| | - Stefano Michelagnoli
- Surgery Department, Vascolar Surgery Unit, S. Giovanni Di Dio Hospital, ASL Toscana Centro, Florence, Italy
| | - Stefano Cantafio
- Surgery Department, Santo Stefano Hospital, ASL Toscana Centro, Prato, Italy
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Kaur J, Stoukides G, Amaturo M. Closed-Loop Gastric Outlet Obstruction Secondary to Duodenal Ulcer in a Patient With Esophageal Stricture. Cureus 2023; 15:e36507. [PMID: 37090344 PMCID: PMC10121273 DOI: 10.7759/cureus.36507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Closed-loop gastric outlet obstruction (GOO) is a rare complication that results from a mechanical obstruction in the pylorus or duodenum. In the early 1990s, the common cause of GOO was peptic ulcer disease, accounting for 5% to 10% of hospital admissions. Peptic ulcer disease is the disruption of the mucosal integrity in the stomach and duodenum and can be categorized into gastric ulcers and duodenal ulcers. With the treatment for Helicobacter pylori and the increased use of proton pump inhibitors (PPI), GOO now occurs in fewer than 5% of patients with duodenal ulcer disease and even less in those with gastric ulcer disease. Although the morbidity of duodenal ulcers has been declining in recent years, the incidence of post-bulbar duodenal ulcer (PBDU) remains at a constant 9.33%, primarily due to diagnostic and therapeutic difficulties. Additionally, fewer than 5% of obstructing duodenal ulcers are caused by PBDU, and even fewer are located in the second or third portions of the duodenum. Ulcers located in the distal part of the duodenum raise concern for syndromes associated with hypersecretion of acid, including Zollinger-Ellison syndrome (ZES). The ZES is rare, accounting only for 0.1% of all duodenal ulcers. Here, we present a case where a patient with esophageal stricture developed a rare case of closed-loop GOO secondary to a duodenal ulcer. The patient, initially treated for esophageal perforation, developed an esophageal stricture. The patient was being worked up for ZES and multiple endocrine neoplasia link type 1 (MEN1) syndrome due to his concerning laboratory findings and rare clinical presentation.
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Affiliation(s)
- Jashandeep Kaur
- Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Georgianna Stoukides
- Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Michael Amaturo
- General Surgery, Jamaica Hospital Medical Center, New York, USA
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