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

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.

Duodenocaval Fistula: Unmasking the Rare Culprit of Gastrointestinal Hemorrhage

“…DCF is commonly seen in middle-aged men in association with traumatic injuries including penetrating abdominal traumas, IVC filter migration, and foreign body ingestion. 4 Remarkably, this patient was the youngest ever diagnosed with DCF, likely playing a role in his survival. This patient's etiology of DCF appears multifactorial, including prior retroperitoneal radiation, peptic ulcer disease (PUD), and vascular endothelial growth factor (VEGF) inhibitor therapy.…”

“…PUD is implicated in nearly 20% of DCF cases, with over 60% of these proving lethal. 4 Literature suggests PUD-associated DCF cases typically exhibit symptoms for 1–4 months prior and occur with large ulcers ranging in size from 1.5 to 9 cm. 4 , 8 …”

“… 4 Literature suggests PUD-associated DCF cases typically exhibit symptoms for 1–4 months prior and occur with large ulcers ranging in size from 1.5 to 9 cm. 4 , 8 …”

“…While 4 reported cases associate DCF with the antiangiogenic bevacizumab, this case marks the first associated with lenvatinib. 4 , 9 – 11 These 2 drugs share similar mechanisms, with bevacizumab directly inhibiting VEGF and lenvatinib indirectly inhibiting VEGF through its tyrosine kinase receptor. The SELECT trial demonstrated 1.5% of patients on lenvatinib developed a gastrointestinal fistula or perforation.…”