ABSTRACT
We report on two cases of duodenocaval fistula. The first patient, a 73-year-old man, had sepsis and occult digestive bleeding. We diagnosed a fistula that resulted from a right nephrectomy and subsequent radiotherapy for a urothelial tumor 20 months earlier. The second patient, a 60-year-old woman, complained of right abdominal pain. A duodenocaval fistula that was caused by duodenal perforation by a migrating caval filter placed 10 years earlier was revealed by means of endoscopy. Both patients had a successful operation to treat the condition. An extensive review of the literature disclosed 35 other cases and identified two factors of good prognosis: duodenocaval fistulas caused by migrating caval filters and early surgery.
Subject(s)
Duodenal Diseases/surgery , Intestinal Fistula/surgery , Vascular Fistula/surgery , Vena Cava, Inferior/surgery , Aged , Duodenal Diseases/diagnostic imaging , Duodenal Diseases/etiology , Female , Foreign-Body Migration/complications , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/surgery , Humans , Intestinal Fistula/diagnostic imaging , Intestinal Fistula/etiology , Male , Middle Aged , Prognosis , Risk Factors , Tomography, X-Ray Computed , Vascular Fistula/diagnostic imaging , Vascular Fistula/etiology , Vena Cava Filters , Vena Cava, Inferior/diagnostic imagingABSTRACT
BACKGROUND: Barrett's ulcer, which develops within Barrett's esophagus, is frequently responsible for bleeding. Perforation is a rare complication constituting a great challenge for diagnosis and management. METHODS: Three personal cases and 31 published reports of perforated Barrett's ulcer were reviewed retrospectively. The site of perforation, clinical presentation, management, and outcome were assessed. RESULTS: The clinical presentation proved to be heterogeneous and was determined by the site of perforation: this was the pleural cavity (20% of cases), mediastinum (20%), left atrium (16.6%), tracheobronchial tract (13.3%), aorta (13.3%), pericardium (10%), or pulmonary vein (6.6%). Early esophagectomy and esophageal diversion-exclusion were the most frequent procedures, and overall mortality was 45%. CONCLUSIONS: The poor prognosis of perforated Barrett's ulcer should be improved by earlier diagnosis and adequate emergent operation. Although early esophagectomy constitutes the recommended procedure, esophageal diversion-exclusion, which allows control of both sepsis and bleeding, is also of interest.
