Aortoazygos fistula from gunshot wound to the suprarenal abdominal aorta.

Missile injury to the suprarenal abdominal aorta is particularly morbid. Most patients with this injury succumb before arrival in the emergency room. The reported case is unique in that the aortic injury spontaneously decompressed into the azygos vein system, allowing early hemodynamic stability. Diagnostic and therapeutic problems included the lack of evidence of azygos dilatation on the early X-ray and difficulty in achieving control of the false aneurysm and fistula. We recommend exploration of all periaortic hematomas.