# Duodenocaval Fistula Caused by Post-Bulbar Duodenal Ulcer: A Case Report

## TL;DR

A rare case of a life-threatening duodenocaval fistula caused by a duodenal ulcer is reported, with successful treatment involving surgery and antimicrobial therapy.

## Contribution

This case report adds to the limited literature on duodenocaval fistulas caused by duodenal ulcers and highlights effective treatment strategies.

## Key findings

- DCF caused by duodenal ulcers has a higher mortality rate than other causes.
- Early broad-spectrum antibiotics and antifungal therapy may improve outcomes.
- Emergency surgery combined with biliary drainage and decompression can be effective.

## Abstract

Duodenocaval fistula (DCF) is a rare, life-threatening disease with a mortality rate of approximately 40%. There are several types of etiologies for DCF. Among these, duodenal ulcers are the most dangerous, with a mortality rate of 63.6%. This report describes a case of DCF caused by a duodenal ulcer that was successfully diagnosed and treated, and discusses why duodenal ulcer-induced DCF results in severe outcomes, with a review of the literature.

A 64-year-old male patient was transferred to our hospital for surgical treatment of DCF. An emergency laparotomy was performed. We opened the abscess cavity, repaired the perforation site and inferior vena cava, and performed gastrojejunostomy. After the operation, anastomotic leakage was suspected. Although we treated him with antibiotics and antifungal drugs, his condition did not improve, and he experienced elevated total bilirubin and inflammation. Therefore, we decided to perform a reoperation on postoperative day (POD) 30, including cholecystectomy, insertion of a C-tube into the common bile duct for biliary drainage, enterostomy, and peritoneal irrigation and drainage. After that, the patient continued antibiotic and antifungal therapy, with periodic drain flushing and replacement. His condition slowly improved, and he was transferred to another facility for rehabilitation on POD 158.

DCF caused by duodenal ulcers has a higher mortality rate than that caused by other etiologies. Therefore, initiating broad-spectrum antibiotics and antifungal therapy early may be beneficial. Also, it is reasonable to perform simple, rapid, and minimally invasive surgery in an emergency setting. However, even in emergency situations, duodenal decompression, cholecystectomy, and biliary drainage should be performed to prevent anastomotic leakage and biliary complications.