Charles D. Hafner

Impending Gangrene of Four Extremities Secondary to Ergotism

TO encounter late at night a young nurse with impending gangrene of all four extremities secondary to ergotism is a frightening experience, and one that impresses the physician with the paucity of ...

Acute abdominal aorto-vena caval fistula. Report of 2 cases.

From the Department of Surgery and the Peripheral Vascular Laboratory, Good Samaritan Hospital, and the University of Cincinnati College of Medicine, Cincinnati, Ohio. The most common cause of abdominal aorto-vena caval fistula is trauma, in which case the communication may be small and unrecognized. The development of an aorto-caval fistula associated with an arteriosclerotic aneurysm is quite rare, as pointed out in a review of the literature by Beall.,, However, occasional case reports2-12 have appeared since the first successful surgical repair was performed by Cooley in 1954.4 These arteriovenous fistulas may be small and remain relatively asymptomatic until cardiac failure or complication of the associated abdominal aortic aneurysm occurs. In this event, rupture of the aneurysm may be the first manifestation of the two associated lesions. On the other hand, a sudden large perforation of the abdominal aortic aneurysm into the inferior vena cava may initiate an onset of catastrophic clinical symptoms and signs as to suggest vena caval involvement. The cases comprising this report are examples of the two different clinical situations described above.