Inferior vena cava graft-enteric fistula after extended hepatectomy with caval replacement

A case of an inferior vena cava (IVC) graft-enteric fistula manifesting with recurrent sepsis 11 years after a right hepatectomy extending to segments I and IV, the extrahepatic bile duct, and IVC followed by chemotherapy and external-beam radiation therapy is described. A preoperative workup reveal...

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Bibliographic Details
Published in:Journal of vascular surgery 2012, Vol.55 (1), p.226-229
Main Authors: Addeo, Pietro, MD, Rosso, Edoardo, MD, Oussoultzoglou, Elie, MD, Jaeck, Daniel, MD, PhD, FRCS, Pessaux, Patrick, MD, PhD, Bachellier, Philippe, MD
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Blood Vessel Prosthesis Implantation - adverse effects
Device Removal
Female
Graft Occlusion, Vascular - diagnosis
Graft Occlusion, Vascular - etiology
Graft Occlusion, Vascular - surgery
Hepatectomy - adverse effects
Human health and pathology
Humans
Intestinal Fistula - diagnosis
Intestinal Fistula - etiology
Intestinal Fistula - surgery
Kidneys
Life Sciences
Magnetic Resonance Angiography
Medical sciences
Nephrology. Urinary tract diseases
Phlebography - methods
Recurrence
Reoperation
Sepsis - etiology
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Thrombosis - diagnosis
Thrombosis - etiology
Thrombosis - surgery
Tomography, X-Ray Computed
Treatment Outcome
Tumors of the urinary system
Vascular Fistula - diagnosis
Vascular Fistula - etiology
Vascular Fistula - surgery
Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
Vena Cava, Inferior - diagnostic imaging
Vena Cava, Inferior - surgery
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Summary:A case of an inferior vena cava (IVC) graft-enteric fistula manifesting with recurrent sepsis 11 years after a right hepatectomy extending to segments I and IV, the extrahepatic bile duct, and IVC followed by chemotherapy and external-beam radiation therapy is described. A preoperative workup revealed graft thrombosis with air bubbles inside the lumen. Laparotomy found a chronic fistula between the graft and the enteric biliary loop. Removal of the graft without further vascular reconstruction, a take-down of the biliary loop, and a redo hepaticojejunostomy were performed successfully. The diagnostic challenges, possible etiology, and therapeutic implications of this case are discussed.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2011.05.118