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Treatment of a duodenal-caval fistula secondary to peptic ulcer disease
Ezra Y Koh1, Ross G McFall1, Raghave Upadhyaya1
1Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX.
Insights
A rare duodenal-caval fistula occurred after peptic ulcer surgery. This case highlights the importance of recognizing this complication and its surgical management.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Surgical Case Reports
Background:
- Peptic ulcer disease can lead to serious complications.
- Previous surgical repair of perforated duodenal ulcers carries risks.
- Gastrointestinal bleeding is a potential post-operative complication.
Observation:
- A 46-year-old male presented with upper gastrointestinal bleeding one month after a Graham patch repair for a perforated duodenal ulcer.
- Imaging studies, including computed tomography and upper endoscopy, confirmed a duodenal-caval fistula.
Findings:
- Duodenal-caval fistula is a rare but life-threatening complication.
- Diagnosis requires advanced imaging and endoscopic confirmation.
- Staged surgical repair involving inferior vena cava thrombectomy, pyloric exclusion, and gastrojejunostomy is a viable treatment option.
Implications:
- This case underscores the need for vigilance in patients with a history of peptic ulcer surgery presenting with gastrointestinal bleeding.
- Early diagnosis and appropriate surgical intervention are crucial for managing duodenal-caval fistulas.
- Further research into preventative strategies and optimized surgical techniques for this rare complication is warranted.
Abstract:
We have reported the case of a duodenal-caval fistula in a 46-year-old man with peptic ulcer disease. He had previously undergone an open Graham patch repair for a perforated anterior duodenal ulcer and had presented 1 month after surgery with an upper gastrointestinal bleeding episode. A duodenal-caval fistula was diagnosed after computed tomography and was confirmed by upper endoscopy. The patient underwent staged repair of his duodenal-caval fistula with inferior vena cava thrombectomy, pyloric exclusion, and gastrojejunostomy creation.
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