Ruptured abdominal aortic aneurysm with fistula into the inferior vena cava

Area of Science:

• Vascular Surgery
• Aortic Aneurysm Research
• Gastrointestinal Surgery

Background:

• Aortocaval fistula is an uncommon complication associated with ruptured abdominal aortic aneurysms (AAA).
• Ruptured AAAs can present with diverse clinical manifestations depending on the rupture site.
• Understanding the hemodynamics and anatomical relationships is crucial for timely diagnosis and management.

Observation:

• This report details a rare case of a ruptured abdominal aortic aneurysm with simultaneous rupture into the retroperitoneum and the inferior vena cava (IVC).
• The patient presented with a complex clinical scenario due to the dual rupture.
• Diagnostic imaging was essential to delineate the fistula and associated hematoma.

Findings:

• The coincident rupture created an aortocaval fistula, leading to significant venous hypertension and potential hemodynamic instability.
• Surgical intervention was required to manage the ruptured AAA and the aortocaval fistula.
• Successful repair involved addressing both the aortic defect and the caval communication.

Implications:

• This case underscores the importance of considering aortocaval fistula in the differential diagnosis of ruptured AAA, especially with atypical presentations.
• Prompt diagnosis and aggressive surgical management are critical for improving patient outcomes in such complex cases.
• Further research into the biomechanics of AAA rupture into adjacent venous structures may refine treatment strategies.