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Spontaneous Aortosigmoid Fistula

Kuruganti R. Reddy, MD; Richard M. Stillman, MD
JAMA. 1982;247(18):2565-2566. doi:10.1001/jama.1982.03320430069035.
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SPONTANEOUS rupture of an infrarenal abdominal aortic aneurysm into retroperitoneum or peritoneal cavity is a catastrophic event. Erosion into adjacent duodenum or esophagus is even more lethal. There have even been rare reports of spontaneous aneurysmal rupture into inferior vena cava and fascia. The only hope for survival in any of these cases is high awareness and early recognition so that timely operative intervention can be undertaken.1

Although rupture of aortic prosthetic grafts into small and large intestine2 has been reported, we have now seen a case of spontaneous aortosigmoid fistula.

Report of a Case  A 79-year-old woman with a three-day history of dyspnea, abdominal pain, and painful swelling of her left thigh was admitted with congestive heart failure. Medical history included poorly controlled hypertension. On physical examination her temperature was 37.8 °C; BP, 150/90 mm Hg; pulse rate, 120 beats per minute; and respirations, 30/min. She had


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