Perera Ganesha B, Wilson Samuel E, Barie Philip S, Butler John A
Department of Surgery, University of California, Irvine Medical Center, Orange, 92068, USA.
Ann Vasc Surg. 2004 Jan;18(1):52-8. doi: 10.1007/s10016-003-0097-8. Epub 2004 Jan 20.
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.
十二指肠腔静脉瘘（DCF）是一种罕见的病理情况，在先前报道的36例患者中，其死亡率为40%。虽然经常提到的病因包括异物迁移或摄入、创伤和消化性溃疡疾病，但已有11例患者在切除腹膜后肿瘤后发生DCF，其中9例还接受了术后放疗。我们报告2例患者，在切除腹膜后肿瘤并接受放疗后发生DCF。第一例患者为56岁女性，在成功切除腹膜后平滑肌肉瘤并置换下腔静脉后7年，因十二指肠假体腔静脉瘘出现上消化道出血，需要输血，随后接受了放疗和化疗。第二例患者为37岁男性，此前接受过腹膜后肉瘤切除及外照射放疗，继发十二指肠腔静脉瘘后出现大量上、下消化道出血。本文分析了DCF的病因、诊断和治疗，重点关注腹膜后肿瘤切除及放疗后的DCF。在大多数患者中，“自发性”DCF是右肾癌或腹膜后结构癌大剂量放疗的晚期并发症。
