A Rare Case of Gastro-Caval Fistula Due to Penetrating Trauma: A Vital Emergency

Abstract

In the literature no case of gastro-caval fistula due to penetrating trauma has been reported. We aimed to present a case of gastro-caval fistula presenting with massive hematemesis after a penetrating injury. A 20-year-old male patient applied to the emergency department with a complaint of projectile hematemesis after a knife penetrated the epigastric region. Contrast-enhanced abdominal computerized tomography (CT) showed a large hematoma around the inferior vena cava (IVC) and a fistula tract extending between the IVC and the gastric antrum. The patient underwent vena cava ligation and primary gastric repair. The patient, who was hypotensive and intubated in the post-operative intensive care unit, died on the second day after the operation. Because of the risk of sudden hypotension and shock from massive bleeding, gastro-caval fistula should be kept in mind in penetrating trauma; a rapid diagnosis should be made using a contrast-enhanced CT scan.

Keywords: computerized tomography (CT); gastro-caval fistula; trauma.

Figure 1. Contrast-enhanced axial computerized tomography scan shows a large paracaval hematoma (black arrow),gastrocaval fistula (blue arrow), and active extravasation to the gastric lumen (white arrow).