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Published on: July 11, 2013

A case of aortoenteric fistula following abdominal aortic reconstruction

Koji Tsutsumi1, Yoshinobu Sato, Mikihiko Ookura

  • 1Division of Cardiovascular Surgery, Sagamihara Kyodo Hospital, Sagamihara, Japan.

Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
|August 25, 2007
PubMed

Insights

A graft-enteric fistula, a rare complication of abdominal aortic reconstruction, may arise from sigmoid colonic ischemia. This case highlights the challenges in preventing and managing this serious vascular surgery complication.

Area of Science:

  • Vascular Surgery
  • Gastrointestinal Surgery
  • Surgical Complications

Background:

  • Abdominal aortic reconstruction is a complex procedure with potential complications.
  • Graft-enteric fistula is a rare but severe complication following aortic reconstruction.
  • Mesocolonic injury during surgery can lead to ischemic complications affecting the colon.

Observation:

  • A 64-year-old male developed a graft-enteric fistula post-abdominal aortic reconstruction.
  • The fistula was suspected to be secondary to sigmoid colon ischemia from mesocolonic injury.
  • Despite sigmoid colonic exteriorization, the fistula could not be prevented.

Findings:

  • Two emergent operations were required for management: bilateral extra-anatomical axillofemoral bypass grafts with infected graft removal, and repair of left common iliac artery stump disruption.
  • The patient remained complication-free for 3 years post-intervention.
  • The patient ultimately died of aortic stump disruption 43 months after the final operation.

Implications:

  • This case underscores the critical importance of meticulous surgical technique to avoid mesocolonic injury during abdominal aortic reconstruction.
  • Management of graft-enteric fistula requires complex, multi-stage surgical interventions.
  • Long-term surveillance is essential, as late complications like aortic stump disruption can occur years after initial repair.

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