[Aorto-caval fistula due to a ruptured abdominal aortic aneurysm--an emergency operation following echoic diagnosis]

A successful emergency operation for a 75-year-old man with aorto-caval fistula secondary to rupture of the abdominal aortic aneurysm is reported. A definite diagnosis of aorto-caval fistula was made by echography with characteristic engorgement of the caval vein. Clinical signs and symptoms characterized by lung edema, sudden onset, and circulatory collapse were also noticeable. In the operation, the fistula was closed via inside of the aneurysm with several mattress sutures following control of aortic flow and opening of the aneurysm. Back-flow of the blood through the fistula was readily controlled by finger tip. The aneurysm was replaced conventionally by a vascular prosthesis. There might be several suitable surgical selection available properly to individual case. No delay in surgical treatment depending on definite diagnosis by echography in such urgent condition should be stressed.