Primary Aorto-Duodenal Fistula as a Late Complication of Radiotherapy: Report of a Case and Review of the Literature (original) (raw)
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Radiation therapy-induced aortoesophageal fistula: a case report and review of literature
Gastroenterology report, 2014
Aortoesophageal fistula (AEF) is a rare cause of massive upper gastrointestinal hemorrhage. Thoracic aortic aneurysm, esophageal foreign body, esophageal cancer and post-surgical complications are common causes of AEF; however, AEF induced by radiation therapy is a rare phenomenon and seldom described in the literature. It is a catastrophic condition which requires rapid implementation of resuscitative measures, broad-spectrum antibiotics and surgical or endovascular intervention. Transthoracic endovascular aortic repair (TEVAR) is a newer and less invasive technique, which helps to achieve rapid hemostasis in patients with severe hemodynamic instability and offers advantages over conventional repair of the aorta in emergency situations. However initial TEVAR should be followed up with a more definitive surgical repair of the aorta and the esophagus, to lower the mortality rate and achieve better outcomes. We describe here a case of a seventy-year-old male who presented with massive...
Spontaneous Enterocutaneous Fistula 27-years Following Radiotherapy in a Patient of Carcinoma Penis
World Journal of Surgical Oncology, 2003
Background: Radiotherapy in the radical doses can produce severe and often irreversible damage to the gut in the form of fibrosis, necrosis and fistulae formation. A previous pelvic surgery makes the gut extra-vulnerable. This is on account of adhesions to the pelvic wall, unless special care is taken during surgery to keep it out of the harms way, during adjuvant radiotherapy. These effects range from acute, to sub acute and delayed chronic manifestations like in the reported case.
Duodenocaval Fistula: A Late Complication of Retroperitoneal Irradiation and Vena Cava Replacement
Annals of Vascular Surgery, 2004
Duodenocaval fistula (DCF), an unusual pathology, is associated with a 40% mortality rate in the 36 patients previously reported. Although migrating or ingested foreign bodies, trauma, and peptic ulcer disease are often described etiologies, 11 patients have been described who developed DCF after resection of retroperitoneal tumors, 9 of whom also had postoperative radiotherapy. We report two patients who developed DCF after resection of retroperitoneal tumors followed by radiation therapy. The first patient, a 56-year-old female, presented with upper gastrointestinal hemorrhage requiring transfusion caused by a duodenoprosthetic caval fistula 7 years after successful resection of a retroperitoneal leiomyosarcoma and replacement of the inferior vena cava followed by radiation and chemotherapy. The second patient, a 37-year-old male who had previously undergone resection of a retroperitoneal sarcoma followed by external radiotherapy, developed massive upper and lower gastrointestinal bleeding secondary to a duodenocaval fistula. The etiology, diagnosis, and treatment of DCF are analyzed with an emphasis on DCF following resection and irradiation of retroperitoneal tumors. In most patients, ''spontaneous'' DCF have occurred as a late complication of high-dose radiation for carcinoma of the right kidney or retroperitoneal structures.
European Journal of Radiology Extra, 2007
Abdominoperineal resection (APR) is the surgery most commonly performed for cancers involving lower third of the rectum. It is an extensive resection surgery resulting in the disturbed anatomy of pelvic fossa. With the introduction of chemo radiotherapy, the control rate and survival figures have gone up with the associated increase in the treatment related toxicities. We present an extremely unusual complication of entero-anal fistula following APR and radiation therapy in a 40-year-old male with rectal carcinoma. The present report describes the possible cause for the development of this rare event along with highlighting some of the important issues that needs to be considered under such conditions.
Ureteroiliac Artery Fistula in a Young Woman with Short Bowel Syndrome for Radiation Enteritis
Case Reports in Medicine, 2010
Ureteral-iliac artery fistula is a rare and potentially life-threatening complication, typically occurring after radiation therapy in already surgically treated cancer patients. This case report describes the diagnostic challenges and the successful management, with the positioning of an intra-arterial prosthesis, of a fistula between the internal iliac artery and the left ureter presenting as massive hematuria in a young woman with history of total colectomy and pelvic radiotherapy for rectal cancer and subsequent wide ileal resections and bilateral ureteral stent positioning for radiation enteritis. Ureteroiliac artery fistulas require a prompt diagnosis and intervention, to avoid life threatening clinical events.
Arterial occlusive disease after radiotherapy: a report of fourteen cases
Radiotherapy and Oncology, 1990
Fourteen cases of arterial occlusion or severe narrowing following radiotherapy are studied in order to assess the possible etiological role of such therapy in arterial lesion. Surgical results are also discussed in terms of long-term efficacy. The average time of occurrence after radiotherapy was 8 years post-radiotherapy. This series includes 7 supra-aortic trunk stenoses and 7 abdominal aorta trunk stenoses. The doses received in the volumes irradiated ranged from 47 to 70 Gy with standard fractionation. Association of atherosclerotic risk factors (smoking, hyperlipidemia, diabetes, high blood pressure) was present in 12 patients, but stenoses were usually confined to irradiated areas, and at times occurred in uncommon sites. Surgical management included 11 by-passes, 2 endarterectomies and one percutaneous transluminal angioplasty. All patients experienced immediate and satisfactory functional improvements. Three patients were re-operated on because of the re-occlusion of the by-pass (2 cases) and graft infection (1 case). On the whole, stenoses in previously irradiated areas showed no particular di#iculties for surgical treatment. It was concluded that radiotherapy seems to be a definite risk factor for arterial occlusion or narrowing, especially in association with atherosclerotic risk factors.
P0057 Aortoduodenal Fistula: A Rare Cause of Gastrointestinal Bleeding
European Journal of Internal Medicine, 2009
Background: Aortoenteric fistula(AEF) is a rare and deadly vascular complication usually secondary to aortic aneurysmal graft repair causing massive bleeding. Recurrent AEF, years after the initial repair, is an even rarer occurrence. Case presentation: We present a case of a 58 year old male with history of abdominal aortic aneurysm, who was brought to the emergency department (ED) after being found unresponsive with a visual approximation by EMT of 500ml of bright red blood per rectum. Unlike many previous case reports our patient's recurrent fistula occurred years after second repair in 2012. Conclusions: Although rare, abdominal aortic aneurysm (AAA) repair can form enteric fistula causing massive bleeding which is a medical emergency. Patient can present with hemodynamic instability. Urgent vascular imaging and repair is necessary for the management.
Late radiation injury of the colon and rectum
Diseases of the Colon & Rectum, 1989
After a median latency of 2 years, the initial late colorectal radiation injuries in 182 patients were: stricture (37 percent), minor lesions (36 percent), rectovaginal fistula (22 percent), and gangrene or other fistulas (5 percent). Due to progression, new colorectal injuries, primarily stricture (55 percent) and fistula (42 percent), occurred in 68 patients (37 percent). Resection provided the best results. However, the resectability rate was low (46 percent) and resection was primarily performed in patients with a circumscript well-defined stricture of the proximal rectum or sigmoid colon with an anastomotic leakage rate of 5 percent. The prevailing management of 78 patients with fistula or stricture with synchronous fistula was defunctioning colostomy, primarily end-sigmoidostomy, providing fair results in half of the patients. Stomal complications occurred in 15 percent. The radiation-induced colorectal mortality was 8 percent. Colorectal fistula and associated radiation injuries of the urinary tract, and especially of the small bowel, were the major determinants of fatal outcome, yielding an overall radiation-induced mortality of 25 percent. After a median observation time of 13 years, half of the patients were alive at follow-up; 56 percent of these had a fair outcome whereas the remaining patients continued to have mild symptoms responding to conservative measures (34 percent) or disabling symptoms (10 percent).