Spontaneous duodenal-caval fistula with embolization of intestinal contents

We describe the second example of a duodenal-caval fistula in a patient with peptic ulcer disease. This condition was complicated by embolization of intestinal contents to the lung, with abundant intravascular mucin. This is the first histological documentation of intravascular mucin apart from amniotic fluid embolism. It is well known that mucin may activate coagulation. We propose that intravascular mucin activated the coagulation cascade in our patient, causing disseminated intravascular coagulation and adult respiratory distress syndrome.