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HOME > J Trauma Inj > Volume 28(4); 2015 > Article
Arteriovenous Fistula between Renal Artery and Inferior Vena Cava following Penetrating Abdominal Trauma; A Case Report
Joong Suck Kim, Seung Je Go, Ji Dae Kim, Young Hoon Sul, Jin Bong Ye, Sang Soon Park, Gwan Woo Ku, Yeong Cheol Kim
Journal of Trauma and Injury 2015;28(4):262-265
Published online: December 31, 2015
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1Department of Surgery, Trauma Center, Eulji University Hospital, Daejeon, Korea.
2Department of Radiology, Trauma Center, Eulji University Hospital, Daejeon, Korea.
3Department of Thoracic and Cardiovascular Surgery, Trauma Center, Eulji University Hospital, Daejeon, Korea.
Received: 8 October 2014   • Revised: 23 November 2015   • Accepted: 9 December 2015

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.

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