Vascular-enteric fistulas associated with radiation therapy in patients with pancreatic adenocarcinoma.

BACKGROUND: Irradiation therapy is being evaluated widely as an adjunct to therapy of resectable and unresectable pancreatic exocrine carcinoma. Exsanguinating haemorrhage has been an occasional late complication. CASE OUTLINES: Two patients with unresectable cancer of the pancreas were treated by bypass, chemotherapy and both intra-operative and postoperative irradiation. Both patients died 5-11 months later of gastroduodenal haemorrhage from arterio-enteric fistulas, which were confirmed by autopsy but had been uncontrolled by selective embolisation. A third patient, for whom little other information was available, died of upper abdominal haemorrhage 5 months after a 'curative' resection combined with intra-operative and postoperative irradiation. DISCUSSION: Judgement in management is difficult because of the poor prognosis from the underlying disease on the one hand versus the fact that site of bleeding has sometimes been from complicating benign disease. Better endovascular techniques of control of such haemorrhage may be developing.