ACUTE SUPRARENAL AORTOGASTRIC FISTULAS CAUSED BY GUNSHOT WOUNDS - THEIMPORTANCE OF EARLY RECOGNITION IN DIRECTING SURGICAL STRATEGY

Penetrating suprarenal aortic injuries carry high mortality rates, Dif ficulties in surgical exposure and bleeding control in this area add t o the ominous prognosis, In rare occasions, synchronous injury to the adjacent upper part of stomach may lead to an acute aortogastric fistu la, resulting in aortic bleeding into the stomach instead of the perit oneal cavity. Filling of the stomach with blood may temporarily tampon ade the aortic perforation, Distortion of this delicate communication during dissection before proximal and distal vascular control is achie ved could result in catastrophic hemorrhage. Therefore, recognition of the importance of a fully distended stomach at the suspicion of aorti c injury is essential in directing a particular surgical strategy that aims to achieve an unrestricted operative exposure and successful ble eding control.