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[Traumatic aorto-caval fistula (author's transl)]
Insights
A traumatic aorto-caval fistula developed after a thoracoabdominal injury. Surgical obliteration and nephrectomy were successful, with alternative treatments suggested.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Nephrology
Background:
- A 33-year-old male presented with a thoracoabdominal bullet injury.
- Initial exploration revealed liver lacerations and gastric perforation.
Observation:
- Two months post-injury, the patient developed bilateral pleural effusion, hypertension, and heart failure.
- A continuous murmur was noted in the right hypochondrium.
- Aortography confirmed an aorto-caval fistula near the right renal artery and a non-functioning right kidney.
Findings:
- An aorto-caval fistula was successfully treated with external obliteration.
- A right nephrectomy was performed due to the non-functioning kidney and fistula complications.
- Heavy adhesions complicated the surgical approach.
Implications:
- This case highlights a rare complication of thoracoabdominal trauma.
- External fistula obliteration combined with nephrectomy is a viable treatment option.
- Profound hypothermia/circulatory arrest and aortic compressors/open fistulectomy were considered alternatives.
Abstract:
A 33-year-old man sustained a thoracoabdominal bullet injury discovered on exploration to have tears in the liver and perforation in the stomach. Two months later admitted for bilateral serosanguinous pleural effusion, hypertension, heart failure and continuous murmur heard at the right hypochondrium. Aortogram showed aorto-caval fistula at the site of the injured right renal artery and a non-functioning right kidney. Successful external obliteration technique of the fistula had to be performed because of the heavy adhesions encountered, together with right sided nephrectomy. Two other alternative methods of treatment were suggested namely the application of profound hypothermia and circulatory arrest or the use of the aortic compressors and open fistulectomy.