DUODENAL CAVAL FISTULA - A RARE CAUSE OF UPPER GASTROINTESTINAL-BLEEDING

Non-traumatic duodenocaval fistulae are rare, but may be the source of massive gastrointestional bleeding with associated fever and sepsis. These fistulae result from penetrating duodenal peptic ulcers or right nephrectomy and subsequent radiation to the upper abdomen. The outcom e depends on early diagnosis and surgery before a potentially fatal he morrhage occurs. The therapy of choice includes closure of the fistula and repair of the duodenum and inferior vena cava. We describe the se venth case with radiogenic duodenum ulcer. Gastrointestinal bleeding o ccurred 10 years after radical nephrectomy and radiation (60 Gy). The patient survived following partial pancreatoduodenectomy (Whipple).