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Case Reports in Surgery
Volume 2012, Article ID 123081, 4 pages
http://dx.doi.org/10.1155/2012/123081
Case Report

Clinical Manifestations of Aortocaval Fistulas in Ruptured Abdominal Aortic Aneurysm: Report of Two Cases

Second Department of Propaedeutic Surgery, Laiko Hospital, Medical School, University of Athens, 11527 Athens, Greece

Received 24 September 2012; Accepted 9 October 2012

Academic Editors: J. M. Bernal, S. Bhatt, F. C. Riess, and S. Tatebe

Copyright © 2012 Emmanouil D. Psathas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Aortocaval fistula (ACF) is an unusual complication of ruptured abdominal aortic aneurysm (AAA), involving less than 3–6% of all ruptured cases. The clinical presentation is often obscure, depending on the coexistence of retroperitoneal rupture and hemodynamic instability. Prompt preoperative diagnosis is essential in order to plan the operative approach and improve patient’s outcome. We report the surgical treatment of two patients presented in the emergency department with ACF due to ruptured AAA, each with different clinical presentation, emphasizing the high index of suspicion needed by the clinician to early diagnose and treat this often lethal condition. Operative strategy and special considerations in the management of this subgroup of patients are also discussed.