Sarac M, Marjanovic I, Bezmarevic M, Zoranovic U, Petrovic S, Mihajlovic M. An aortoduodenal fistula as a complication of immunoglobulin G4-related disease. World J Gastroenterol 2012; 18(42): 6164-6167 [PMID: 23155348 DOI: 10.3748/wjg.v18.i42.6164]
Corresponding Author of This Article
Mihailo Bezmarevic, MD, Clinic for General Surgery, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia. bezmarevicm@gmail.com
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Momir Sarac, Ivan Marjanovic, Uros Zoranovic, Clinic for Vascular and Endovascular Surgery, Military Medical Academy, 11000 Belgrade, Serbia
Mihailo Bezmarevic, Clinic for General Surgery, Military Medical Academy, 11000 Belgrade, Serbia
Stanko Petrovic, Clinic for Gastroenterology, Military Medical Academy, 11000 Belgrade, Serbia
Miodrag Mihajlovic, Institute of Radiology, Military Medical Academy, 11000 Belgrade, Serbia
Author contributions: Sarac M, Marjanovic I and Bezmarevic M operated on the patient;Bezmarevic M took the photos and researched sources for the references;Bezmarevic M, Petrovic S, Sarac M and Marjanovic I were engaged in the postoperative treatment;Sarac M, Bezmarevic M, Zoranovic U and Petrovic S participated in the follow up; Mihajlovic M and Petrovic S helped in the interpretation of photos and helped draft the final version of the manuscript;all authors participated in writing the case report and revising the draft.
Correspondence to: Mihailo Bezmarevic, MD, Clinic for General Surgery, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia. bezmarevicm@gmail.com
Telephone: +381-641-994288 Fax: +381-113-608550
Received: April 16, 2012 Revised: July 2, 2012 Accepted: July 9, 2012 Published online: November 14, 2012
Abstract
Most primary aortoduodenal fistulas occur in the presence of an aortic aneurysm, which can be part of immunoglobulin G4 (IgG4)-related sclerosing disease. We present a case who underwent endovascular grafting of an aortoduodenal fistula associated with a high serum IgG4 level. A 56-year-old male underwent urgent endovascular reconstruction of an aortoduodenal fistula. The patient received antibiotics and other supportive therapy, and the postoperative course was uneventful, however, elevated levels of serum IgG, IgG4 and C-reactive protein were noted, which normalized after the introduction of steroid therapy. Control computed tomography angiography showed no endoleaks. The primary aortoduodenal fistula may have been associated with IgG4-related sclerosing disease as a possible complication of IgG4-related inflammatory aortic aneurysm. Endovascular grafting of a primary aortoduodenal fistula is an effective and minimally invasive alternative to standard surgical repair.
