{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T20:29:19Z","timestamp":1780432159169,"version":"3.54.1"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,11,30]],"date-time":"2019-11-30T00:00:00Z","timestamp":1575072000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,11,30]],"date-time":"2019-11-30T00:00:00Z","timestamp":1575072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Foundation of Jiangsu Cancer Hospital","award":["ZM201811"],"award-info":[{"award-number":["ZM201811"]}]},{"name":"Science and Technology Project Foundation of Jiangsu Province","award":["BE2018750"],"award-info":[{"award-number":["BE2018750"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Surg Onc"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Gastric cancer (GC) remains one of the leading causes of cancer-related death. Arteriointestinal fistula is a very rare but lethal postoperative complication in GC patients after gastrectomy. However, very few reports associated with arteriointestinal fistula have been published, and there is no matured diagnosis and treatment consensus for arteriointestinal fistula. Herein, we will investigate the etiology, clinical feature, diagnostic method, treatment, and prognosis by summarizing two patients we treated and consulting related cases reported in recent years.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Case presentation<\/jats:title>\n<jats:p>A 61-year-old male and 75-year-old female with advanced gastric cancer of gastric antrum underwent radical distal gastrectomy and D2 regional lymphadenectomy. Residual gastrojejunostomies by the Roux-en-Y method were performed. The two patients recovered well after gastrectomy, and they received postoperative adjuvant chemotherapy. However, both of them suffered sudden hematemesis and melena about 2 months after surgery, resulting in unstable vital signs. Emergency exploratory laparotomy and interventional embolotherapy by digital subtraction angiography were immediately respectively performed. During this process, arteriointestinal fistulas were found in both of them. Pseudoaneurysms of gastroduodenal artery and common hepatic artery were respectively ruptured and bleeding into the duodenum. Finally, the male patient recovered, while the female patient died because of rebleeding and hemorrhagic shock.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Arteriointestinal fistula, with low morbidity but high mortality, is an acute and fatal postoperative complication for GC patients after radical gastrectomy. DSA is the preferred method to diagnose arteriointestinal fistula. Embolotherapy by DSA should be performed immediately once arteriointestinal fistula is confirmed. Emergency laparotomy is another selection if the embolotherapy failed. We should pay more attention to perioperative preventive measures for formation of pseudoaneurysm, which is the leading cause of arteriointestinal fistula.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12957-019-1751-0","type":"journal-article","created":{"date-parts":[[2019,12,2]],"date-time":"2019-12-02T10:48:33Z","timestamp":1575283713000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Treatment experience of delayed massive gastrointestinal bleeding caused by intra-abdominal arteriointestinal fistula in gastric cancer patients after radical gastrectomy"],"prefix":"10.1186","volume":"17","author":[{"given":"Liang","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuezhi","family":"Ming","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongmin","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4184-267X","authenticated-orcid":false,"given":"Wei","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huanqiu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,11,30]]},"reference":[{"key":"1751_CR1","doi-asserted-by":"publisher","first-page":"394","DOI":"10.3322\/caac.21492","volume":"68","author":"F Bray","year":"2018","unstructured":"Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394\u2013424.","journal-title":"CA Cancer J Clin"},{"issue":"12","key":"1751_CR2","doi-asserted-by":"publisher","first-page":"2878","DOI":"10.3748\/wjg.v9.i12.2878","volume":"9","author":"DY Kim","year":"2003","unstructured":"Kim DY, Joo JK, Ryu SY, Kim YJ, Kim SK, Jung YY. Pseudoaneurysm of gastroduodenal artery following radical gastrectomy for gastric carcinoma patients. World J Gastroenterol. 2003;9(12):2878\u20139.","journal-title":"World J Gastroenterol"},{"issue":"4","key":"1751_CR3","first-page":"388","volume":"19","author":"K Shen","year":"2016","unstructured":"Shen K, Gao X. Prevention and management of pseudoaneurysm after radical gastrectomy for gastric cancer. Chin J Gastrointest Surg. 2016;19(4):388\u20139.","journal-title":"Chin J Gastrointest Surg"},{"issue":"2","key":"1751_CR4","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1007\/BF02035059","volume":"11","author":"HE H\u00fcgel","year":"1986","unstructured":"H\u00fcgel HE, Oser W, Bodner E. Aneurysm of the proper hepatic artery as a rare source of upper gastrointestinal bleeding. Gastrointest Radiol. 1986;11(2):158\u201360.","journal-title":"Gastrointest Radiol"},{"issue":"2","key":"1751_CR5","doi-asserted-by":"publisher","first-page":"244","DOI":"10.11569\/wcjd.v22.i2.244","volume":"22","author":"L Wang","year":"2014","unstructured":"Wang L, Wan SY, Zhou LB, Wu CL, Qian B, Hou H. Diagnosis and treatment of upper gastrointestinal bleeding caused by pseudoaneurysm rupture following radical gastrectomy. World Chin J Dig. 2014;22(2):244\u20138.","journal-title":"World Chin J Dig"},{"issue":"2","key":"1751_CR6","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1007\/BF02471594","volume":"19","author":"H Satoh","year":"1989","unstructured":"Satoh H, Morisaki T, Kishikawa H. A case of a postoperative aneurysm of the common hepatic artery which ruptured into the remnant stomach after a radical gastrectomy. Jpn J Surg. 1989;19(2):241\u20135.","journal-title":"Jpn J Surg"},{"issue":"7","key":"1751_CR7","first-page":"663","volume":"15","author":"QX Chen","year":"2015","unstructured":"Chen QX, Cai LS, Cai MZ, Lin XL, Huang GP. Introvenous treatment for delayed gastrointestinal tract hemorrhage caused by pseudoaneurysm after gastrectomy: a report of 4 cases. Chin J Min Inv Surg. 2015;15(7):663\u20136.","journal-title":"Chin J Min Inv Surg"},{"issue":"2","key":"1751_CR8","first-page":"157","volume":"14","author":"Q Tong","year":"2005","unstructured":"Tong Q, Lu XM, Qu XC, Wang GB, Chen DD. Treatment of refractory massive upper gastrointestinal bleeding: a report of 11 cases. Chin J General Surg. 2005;14(2):157\u20138.","journal-title":"Chin J General Surg"},{"issue":"1","key":"1751_CR9","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s40792-019-0566-0","volume":"5","author":"M Honda","year":"2019","unstructured":"Honda M, Sakamoto T, Kojima S, Yamamoto Y, Yajima K, Kim DH, et al. Aortoenteric fistula following overlap esophagojejunal anastomosis using linear staplers for cancer of the esophagogastric junction: a case report. Surg Case Rep. 2019;5(1):9.","journal-title":"Surg Case Rep"},{"issue":"11","key":"1751_CR10","doi-asserted-by":"publisher","first-page":"2162","DOI":"10.1007\/s00595-014-0834-3","volume":"44","author":"S Gunji","year":"2014","unstructured":"Gunji S, Okabe H, Obama K, Sakai Y. Aortoenteric fistula at the site of esophagojejunostomy after laparoscopic total gastrectomy: report of a case. Surg Today. 2014;44(11):2162\u20136.","journal-title":"Surg Today"},{"issue":"1","key":"1751_CR11","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1002\/jso.2930490113","volume":"49","author":"VH de Villa","year":"1992","unstructured":"de Villa VH, Calvo FA, Bilbao JI, Azinovic I, Balen E, Hernandez JL, et al. Arteriodigestive fistula: a complication associated with intraoperative and external beam radiotherapy following surgery for gastric cancer. J Surg Oncol. 1992;49(1):52\u20137.","journal-title":"J Surg Oncol"},{"issue":"3","key":"1751_CR12","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1007\/BF00308835","volume":"22","author":"S Guadagni","year":"1992","unstructured":"Guadagni S, De Bernardinis G, Pavone P, Catarci M, Agnifili A, Carboni M. A rare cause of digestive hemorrhage: an aneurysm of the superior pancreaticoduodenal artery rupturing into the duodenal stump of a Billroth II partial gastrectomy. Surg Today. 1992;22(3):273\u20135.","journal-title":"Surg Today"},{"issue":"2","key":"1751_CR13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/jscr\/rjy003","volume":"2018","author":"R Maharaj","year":"2018","unstructured":"Maharaj R, Raghunanan B, Mohammed W, Rambally R, Sookdeo VD, Harnanan D, et al. A rare case of massive lower gastrointestinal bleeding from a ruptured splenic artery aneurysm. J Surg Case Rep. 2018;2018(2):1\u20134.","journal-title":"J Surg Case Rep"},{"issue":"3","key":"1751_CR14","first-page":"492","volume":"96","author":"MS Sweeney","year":"1984","unstructured":"Sweeney MS, Gadacz TR. Primary aortoduodenal fistula: manifestation, diagnosis, and treatment. Surgery. 1984;96(3):492\u20137.","journal-title":"Surgery"},{"issue":"3","key":"1751_CR15","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1111\/j.1445-2197.1998.tb04758.x","volume":"68","author":"AN James","year":"1998","unstructured":"James AN, Clark DA, Colman PD. Primary aortoduodenal fistulas with nine \u2018herald\u2019 bleeds. Aust N Z J Surg. 1998;68(3):245\u20136.","journal-title":"Aust N Z J Surg"}],"container-title":["World Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12957-019-1751-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12957-019-1751-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12957-019-1751-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,29]],"date-time":"2020-11-29T00:08:56Z","timestamp":1606608536000},"score":1,"resource":{"primary":{"URL":"https:\/\/wjso.biomedcentral.com\/articles\/10.1186\/s12957-019-1751-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,30]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["1751"],"URL":"https:\/\/doi.org\/10.1186\/s12957-019-1751-0","relation":{},"ISSN":["1477-7819"],"issn-type":[{"value":"1477-7819","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,30]]},"assertion":[{"value":"31 August 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 November 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 November 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Our study was approved by Ethics Committee of the affiliated cancer hospital of Nanjing Medical University. The patients and relatives were informed and consented to participating this study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Consent for publication had been obtained from the patients and relatives.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"201"}}