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.

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

“…First of all, DCF represents a relatively rare clinical manifestation and only 37 cases have been described [ 9 ]. The occurrence of DCF has been reported in different oncological settings, such as retroperitoneal metastatic cholangiocarcinoma [ 11 ], renal cell carcinoma [ 10 ], urothelial tumor [ 9 ], and uterine adenocarcinoma [ 13 ]. However, to the best of the authors' knowledge, this represents the first case of a DCF in a patient previously treated for an IVC leiomyosarcoma.…”

“…Thus, no further emergency surgical intervention was required in this patient. Conversely, other literature's series showed that palliative endovascular stent graft [ 13 ], prosthesis ablation [ 11 ], digital control of bleeding, suturing of the duodenum and IVC, and the placement of an epiploic or jejunal patch to prevent recurrence [ 16 ] were necessary.…”

“…CT provides a noninvasive evaluation of the IVC and the adjacent structures, allowing a correct identification of DCF in approximately 50% of patients [ 12 ]. CT is able to detect thrombus and air bubbles in the IVC and infectious fluid collections or abscess around the IVC and the duodenum, also allowing the evaluation of collateral vascular outflow [ 12 , 13 ]. Using conventional or flow-sensitive sequences, MRI can clearly demonstrate high-signal enteric contrast medium or thrombus and signal-void air bubbles within the IVC [ 10 ].…”