Acute suprarenal aortogastric fistulae caused by gunshot wounds: The importance of early recognition in directing surgical strategy

Penetrating suprarenal aortic injuries carry high mortality rates. Difficulties in surgical exposure and bleeding control in this area add to the ominous prognosis. In rare occasions, synchronous injury to the adjacent upper part of stomach may lead to an acute aortogastric fistula, resulting in aortic bleeding into the stomach instead of the peritoneal cavity. Filling of the stomach with blood may temporarily tamponade the aortic perforation. Distortion of this delicate communication during dissection before proximal and distal vascular control is achieved could result in catastrophic hemorrhage. Therefore, recognition of the importance of a fully distended stomach at the suspicion of aortic injury is essential in directing a particular surgical strategy that aims to achieve an unrestricted operative exposure and successful bleeding control.