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Fatal duodenocaval fistula caused by peptic ulcer

E P Lesho1, C LeBrun, F J Landry

  • 1Department of Medicine, Madigan Army Medical Center, Tacoma, Wash, USA.

Southern Medical Journal
|September 1, 1996
PubMed

Insights

A rare duodenocaval fistula caused fatal gastrointestinal bleeding in a patient with polymicrobial fungemia. This association suggests a potential link to candidal endocarditis, highlighting diagnostic challenges and high mortality risks.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Vascular Surgery

Background:

  • Duodenocaval fistulas are rare but life-threatening complications, often stemming from peptic ulcers.
  • Gastrointestinal bleeding from these fistulas presents significant diagnostic and management challenges.
  • High mortality rates underscore the severity of this condition.

Observation:

  • A case is presented of a patient experiencing fatal gastrointestinal bleeding due to a duodenocaval fistula.
  • The patient also presented with polymicrobial fungemia, a condition not previously documented with duodenocaval fistulas.
  • The fistula was attributed to an underlying peptic ulcer.

Findings:

  • Polymicrobial fungemia was identified in a patient with a duodenocaval fistula and gastrointestinal bleeding.
  • This represents a novel association between fungemia and duodenocaval fistula formation.
  • The findings suggest a potential, previously unrecognized pathway involving fungal infections.

Implications:

  • The presence of polymicrobial fungemia raises the possibility of candidal endocarditis as a contributing or causative factor.
  • This case broadens the differential diagnosis for gastrointestinal bleeding in critically ill patients.
  • Further investigation is warranted to understand the role of fungal infections in the development of duodenocaval fistulas.

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