Aortocaval fistula
Background
- Complication of abdominal aortic aneurysm
- Rare (<1% of all AAAs, ~3% of ruptured AAAs) but life-threatening (mortality ~50%)
- Caused by inflammation around aorta → adherence of aorta to vein → pressure and erosion into vein → fistula
Clinical Features
- Presentation depends on origin, size, and location of fistula
- Signs/symptoms of AAA (abdominal/flank/back pain, shock if ruptured)
- High-output heart failure
- Pedal edema (due to venous hypertension)
- Renal insufficiency (due to reduced perfusion to kidneys)
- Hematuria
- Bruit
Differential Diagnosis
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Gastroparesis
- Diabetic ketoacidosis
- Hernia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
Evaluation
- US to identify AAA
- CT angio
Management
- Treat hypovolemia/shock
- Emergent surgical repair
Disposition
- Admit
See Also
References
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