Abstract
We report a case of aortocaval fistula (ACF) caused by a ruptured abdominal aortic aneurysm (AAA), presenting with symptoms of acute cardiac failure. A 63-year-old man complained of severe lumbago which was temporarily relieved with NSAIDs. However, a dull pain remained in his back accompanied by cough, bloody phlegm and general fatigue leading to admission to our hospital 4 days later. The initial diagnosis on admission was acute cardiac failure. A contrast-enhanced CT scan revealed an ACF caused by an AAA rupturing the inferior vena cava (IVC) and inducing high-output cardiac failure. At operation, upon opening the aneurysm, we found a ruptured orifice 15 mm in diameter in the aortic wall. The fistula was closed while controlling the venous bleeding from the ACF by digital compression, and the aneurysm was replaced with a Y-shaped prosthetic graft. The postoperative course was uneventful and the patient was discharged on the 16th postoperative day. Aortocaval fistula is a rare complication of AAA, and its preoperative diagnosis is challenging but essential, because early diagnosis and prompt surgical repair improve not only the operative result but also the outcome.
