Duodenocaval Fistula in a Patient with Inferior Vena Cava Leiomyosarcoma Treated by Surgical Resection and Caval Polytetrafluoroethylene Prosthesis

Abstract

Inferior vena cava (IVC) leiomyosarcoma represents an extremely rare disease that commonly involves the segment between the inflow of the renal veins and the inflow of the hepatic veins (46% of cases). We report the case of a patient affected by an IVC leiomyosarcoma, treated with surgical resection, caval reconstruction with polytetrafluoroethylene (PTFE), and right nephrectomy, followed by external beam radiotherapy. Oncological follow-up was negative for 17 years after this combined treatment, since the patient developed a duodenocaval fistula (DCF).

Surgical Resection of Malignancies Invading Inferior Vena Cava Level I and II. Issues Still Need to Be Discussed

“…A duodenocaval fistula has been recently reported in a patient with resection of IVC for leiomyosarcoma replaced by a PTFE graft (11). This underreported complication must be further investigated in future studies.…”

“…However, the resection of large retroperitoneal tumors, as well as the retroperitoneal lymphadenectomy (performed when required), may disrupt the venous collaterals with a significant lower extremity edema in up to 50% of patients when the IVC is ligated. For this reason, it is suggested, whenever possible, to maintain the continuity of IVC by direct suture or replacing it with a prosthesis (9,11). IVC ligation may be considered in some exceptional cases where the inflammatory reaction of the surgical field can be too dangerous for suturing or grafting and only if retroperitoneal lymphadenectomy is not required, like the case of a liver hydatid cyst involving IVC.…”

Duodenocaval Fistula: Unmasking the Rare Culprit of Gastrointestinal Hemorrhage

“…With a mortality rate up to 40%, the elusive nature of DCF frequently leads to devastating outcomes unveiled only during emergent laparotomy or autopsy. 2 Computed tomography only identifies DCF in approximately 50% of cases. 2 , 3 Endoscopy may reveal duodenal ulcers, but the depth of penetration can be underestimated.…”

“… 2 Computed tomography only identifies DCF in approximately 50% of cases. 2 , 3 Endoscopy may reveal duodenal ulcers, but the depth of penetration can be underestimated. 2 Timely surgical intervention is imperative upon diagnosis to circumvent high mortality rates.…”

“… 2 , 3 Endoscopy may reveal duodenal ulcers, but the depth of penetration can be underestimated. 2 Timely surgical intervention is imperative upon diagnosis to circumvent high mortality rates. We present a case of DCF manifesting as gastrointestinal hemorrhage and sepsis in a young patient that highlights the importance of early recognition of DCF and sheds light on associated risk factors.…”