Endovascular Stent Reconstruction of the Inferior Vena Cava Complicated by Duodenocaval Fistula

ABSTRACT

A patient with retroperitoneal metastatic uterine adenocarcinoma resulting in symptomatic occlusion of the inferior vena cava underwent palliative endovascular stent reconstruction and subsequent radiation therapy. She then developed sepsis and massive lower gastrointestinal bleeding. Computed tomography (CT) and cavography demonstrated a fistulous communication between the duodenum and the stented segment of inferior vena cava. Deployment of endovascular stent graft devices successfully occluded the fistulous communication and resulted in clinical improvement.

KEYWORDS

Inferior vena cava - stent graft - enteric fistula - cancer - complication

REFERENCES

• 1 Moran E A, Porterfield Jr J R, Nagorney D M. Duodenocaval fistula after irradiation and resection of a retroperitoneal sarcoma.  J Gastrointest Surg. 2008;  12 (4) 776-778
• 2 Guillem P G, Binot D, Dupuy-Cuny J et al.. Duodenocaval fistula: a life-threatening condition of various origins.  J Vasc Surg. 2001;  33 (3) 643-645
• 3 Schwartz J T, Graham D Y. Toothpick perforation of the intestines.  Ann Surg. 1977;  185 (1) 64-66
• 4 Feezor R J, Huber T S, Welborn III M B, Schell S R. Duodenal perforation with an inferior vena cava filter: an unusual cause of abdominal pain.  J Vasc Surg. 2002;  35 (5) 1010-1012
• 5 Benjamin D S, Ruckle H C, Hadley H R. Local recurrence of renal cell carcinoma causing duodenal-inferior vena caval fistula: case report and review of the literature.  Urology. 1996;  48 (4) 636-638
• 6 Brandão D, Canedo A, Maia M, Ferreira J, Vaz G. Duodenocaval fistula as a result of a fish bone perforation.  J Vasc Surg. 2010;  51 (5) 1276-1278
• 7 Perera G B, Wilson S E, Barie P S, Butler J A. Duodenocaval fistula: a late complication of retroperitoneal irradiation and vena cava replacement.  Ann Vasc Surg. 2004;  18 (1) 52-58
• 8 DuPriest Jr R W, Khaneja S C, Ayella R, Cowley R A. Sepsis and upper gastrointestinal hemorrhage due to duodenal-caval fistula: complications of delayed treatment of a penetrating abdominal injury (case report).  J Trauma. 1979;  19 (4) 275-277
• 9 Allen B, Krupski W C, Wylie E J. Toothpick perforation of the inferior vena cava.  West J Med. 1983;  138 (5) 727-730
• 10 Vitellas K M, Stone J A, Bennett W F, Mueller C F. The hyperdense liver and spleen: a CT manifestation of barium embolization through a duodenocaval fistula.  AJR Am J Roentgenol. 1997;  169 (3) 915-916
• 11 Rioux M, Lacourciere L, Langis P, Rouleau M. Sonographic detection of ingested foreign bodies in the inferior vena cava.  Abdom Imaging. 1997;  22 (1) 108-110
• 12 Guo Y, Zhang Y Q, Lin W. Radiological diagnosis of duodenocaval fistula: a case report and literature review.  World J Gastroenterol. 2010;  16 (18) 2314-2316
• 13 Moran E A, Porterfield Jr J R, Nagorney D M. Duodenocaval fistula after irradiation and resection of a retroperitoneal sarcoma.  J Gastrointest Surg. 2008;  12 (4) 776-778
• 14 Hopper J, Browder W. Successful management of acute traumatic duodenocaval fistula.  J Trauma. 1983;  23 (11) 1015-1016
• 15 Godwin T A, Mercer G, Holodny A I. Fatal embolization of intestinal contents through a duodenocaval fistula.  Arch Pathol Lab Med. 1991;  115 (1) 93-95