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

Abstract

Aorto-enteric and entero-caval 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 (PTFE) Inferior Vena Cava (IVC) graft a year after the resection of a rare metastatic Sertoli-Leydig retroperitoneal tumor and concomitant aorto-caval reconstruction. The patient presented with herald gastrointestinal bleeding and gram-negative bacteremia; and a duodenotomy, graft removal followed by IVC ligation and repeat right aorto-iliac reconstruction were performed. The patient recovered well and following the appropriate postoperative care he was discharged six days after surgery without any further vascular or gastrointestinal complications and with neoadyuvant chemotherapy.

Iliac Artery–Inferior Vena Cava–Duodenal Fistula: An Unusual Cause of Massive Gastrointestinal Bleeding

“…An abnormal connection between the duodenum and IVC, known as duodenocaval fistulas (DCFs), is rare, with approximately 40 cases reported in the literature. 1 Although there are various etiologies of such fistulas, common causes include IVC filter placement/removal, duodenal ulcers, foreign-body trauma, and retroperitoneal tumor resection with radiation. 2 IVC filter placement poses the risk of vessel wall penetration into the duodenum, given the duodenum's close anatomical positioning to the IVC; 9%–24% of filter placement penetrate the IVC.…”

“…Although esophagogastroduodenoscopy can often detect a duodenal ulcer, the extent of the depth of the ulcer and its potential invasion into the IVC can be often missed. 1 Hence, it is important that in patients who present with massive hemorrhaging and concern for gastrointestinal bleed with a history of IVC filter placement or a retroperitoneal mass with radiation treatment, that computed tomography angiography be performed immediately to rule out vasculoenteric fistulas. Finally, given the rarity of occurrence, especially with our case, further research is warranted to better understand the mechanism to which these fistulas form, especially in the setting of chemoradiation and retroperitoneal carcinomas.…”