J Korean Soc Traumatol.  2015 Dec;28(4):262-265. 10.0000/jti.2015.28.4.262.

Arteriovenous Fistula between Renal Artery and Inferior Vena Cava following Penetrating Abdominal Trauma; A Case Report

• Kim JS
• Go SJ
• Kim JD
• Sul YH
• Ye JB
• Park SS
• Ku GW
• Kim YC

• KMID: 2224037
• DOI: http://doi.org/10.0000/jti.2015.28.4.262

Abstract

An arteriovenous fistula (AVF) from the renal artery following a penetrating abdominal trauma is not common. We report the case of a 19-year-old male who presented with a knife stab wound in the right upper quadrant. Due to unstable vital signs and to the protrusion of the mesentery through the stab wound, providing definite evidence of peritoneal violation, an emergent exploratory laparotomy was carried out. There were injuries at the proximal transverse mesocolon and the second portion of the duodenum, with bile leakage. There was also a mild amount of retroperitoneal hematoma near the right kidney, without signs of expansion or pulsation. The mesocolon and the duodenum were repaired. After the operation, abdominal computerized tomography (CT) was performed, which revealed contrast from the right renal artery shunting directly into the vena cava. Transcatheter arterial embolization with a coil and vascular plug was performed, and the fistula was repaired. The patient recovered completely and was discharged without complication. For further and thorough evaluation of an abdominal trauma, especially one involving the retroperitoneum, a CT scan is recommended, when possible, either prior to surgery or after surgery when the patient is stabile. Furthermore, a lateral retroperitoneal hematoma and an AVF after a penetrating trauma may not always require exploration. Sometimes, it may be safely treated non-operatively or with embolization.

Keyword

Penetrating trauma; Renal artery injury; Arteriovenous fistula; Computed tomography

MeSH Terms

Arteriovenous Fistula*
Bile
Duodenum
Fistula
Hematoma
Humans
Kidney
Laparotomy
Male
Mesentery
Mesocolon
Renal Artery*
Tomography, X-Ray Computed
Vena Cava, Inferior*
Vital Signs
Wounds, Stab
Young Adult