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Case Reports
. 2023 Jun 10;2023(6):rjad329.
doi: 10.1093/jscr/rjad329. eCollection 2023 Jun.

Duodenocaval fistula after bevacizumab therapy: case presentation and complete overview of the literature

Alessio Giordano  1 , Francesco Moroni  1 , Alessandra Gosmar  1 , Federico Passagnoli  1 , Juhye Jeong  1 , Francesco Menici  1 , Maddalena Baraghini  1 , Vita M Mirasolo  1 , Laura Campiglia  2 , Stefano Michelagnoli  3 , Stefano Cantafio  1
Affiliations
Case Reports

Duodenocaval fistula after bevacizumab therapy: case presentation and complete overview of the literature

Alessio Giordano et al. J Surg Case Rep. .

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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Conflict of interest statement

Authors certify that there is no actual or potential conflict of interest in relation to this article and they state that there are no financial interests or connections, direct or indirect, or other situations that might raise the question of bias in the work reported or the conclusions, implications or opinions stated—including pertinent commercial or other sources of funding for the individual author(s) or for the associated department(s) or organization(s), personal relationships or direct academic competition.

Figures

Figure 1
Figure 1
CT scan showed the presence of strong adherence between the IVC at the origin of the left renal vein and the third duodenal portion.
Figure 2
Figure 2
In coronal view the arrow points the air inside the vena cava and thrombotic-like hypodense material.
Figure 3
Figure 3
The intraoperative finding confirms the location DCF at the third duodenal portion.
Figure 4
Figure 4
The complete kocherization of the duodenum (1) allowed to better identify the site of the fistula (2) and of the caval thrombus (3) allowing an adequate control of the left renal vein (4).
See this image and copyright information in PMC

References

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    1. Allen B, Krupski WC, Wylie EJ. Toothpick perforation of the inferior vena cava. West J Med 1983;138:727–30. - PMC - PubMed
    1. DeSa LA, Roddie ME, Williamson RC. Fatal duodenocaval fistula resulting from a giant peptic ulcer. Acta Chir Scand 1990;156:647–50. - PubMed

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