Inferior vena cava enteric fistula due to unresected colorectal metastasis

A 57 year old male presented to our department with recurrent attacks of sepsis and upper gastrointestinal bleeding due to colorectal cancer metastasis that resulted in a fistula involving the inferior vena cava and the third part of the duodenum. Four and a half years ago he underwent laparoscopic right hemicolectomy due to colonic adenocarcinoma. A year prior to his recent hospitalization he underwent cytoreductive surgery followed by HIPEC due to peritoneal metastases in another hospital. During the operation a metastasis adherent to the inferior vena cava and the III part of the duodenum was revealed. The surgeon decided to mark the area with hemo- clips and after the patient recovered from surgery he was sent for radiotherapy aimed at controlling the left over metastases. In his current hospitalization he underwent an en bloc resection of the III part of the duodenum, the adherent vena cava and the right kidney. Gross pathology revealed a fistula between the vena cava and the duodenum with bile stained clot within the resected part of the vena cava. The patient recovered well with resolutions of his presenting symptoms.