Severe upper gastrointestinal bleeding from aortoenteric fistula: a late complication of esophagojejunostomy.

Aortoenteric fistula is an uncommon cause of upper gastrointestinal bleeding, which is life-threatening if not treated. This complication may occur even months to years after surgery [Mitchel 1995]. It is commonly observed in patients who have undergone previous aortic surgery and rarely occurs in patients with a history of gastrointestinal tract surgery [Brock 1953]. The diagnosis of aortoenteric fistula depends on a high level of clinical suspicion. Herein, we report a case of a 53-year-old man who underwent surgical treatment because of new-onset severe gastrointestinal bleeding that was related to an aortoenteric fistula.

Radioembolization with yttrium-90 resin microspheres for neuroendocrine tumor liver metastases.

PURPOSE: We aimed to evaluate the effectiveness and safety of radioembolization with yttrium-90 (90Y) microspheres in cases with unresectable neuroendocrine tumor liver metastases (NETLMs). METHODS: Thirty patients (mean age, 55 years) underwent resin-based 90Y radioembolization for unresectable NETLM at a single institution between April 2008 and June 2013. Post-treatment tumor response was assessed by cross-sectional imaging using the Response Evaluation Criteria in Solid Tumors (RECIST). Prognostic variables that affected survival were determined. RESULTS: The mean follow-up was 23.0±19.4 months and the median overall survival was 39 months (95% CI, 12.6-65.4 months), with one- and two-year survival rates of 71% and 45%, respectively. Imaging follow-up using RECIST at three-month intervals demonstrated partial response in 43%, complete remission in 3%, stable disease in 37%, and progressive disease in 17% of patients. Extent of tumor involvement was found to have a statistically significant influence on overall survival (P = 0.03). The existence of extrahepatic disease at the time of radioembolization, radiographic response, age, and primary neuroendocrine tumor site were not significant prognostic factors. CONCLUSION: The current study demonstrates the effectiveness and safety of radioembolization for the treatment of unresectable NETLMs. We identified that the extent of tumor involvement has a significant effect on overall survival. The use of imaging methods reflecting metabolic activity or cellularity such as scintigraphy or diffusion-weighted MRI would be more appropriate, for the response evaluation of liver metastases after radioembolization.