Secondary aortoenteric fistula: a case report of acute aortic occlusion following cellulitis

A secondary aortoenteric fistula is a relatively rare complication of abdominal aortic reconstruction. The clinical manifestation of aortoenteric fistula is usually upper gastrointestinal bleeding. We report a patient who developed acute aortic occlusion following chronic cellulitis, which is an uncommon finding. A 50-year-old man with a history of aortobifemoral bypass grafting was admitted for tiredness, fever and swelling of his right leg. On the 40th day of admission, he developed acute aortic occlusion. Computed tomography revealed right distal aortic graft occlusion and the presence of gas surrounding the graft. Gastroduodenoscopy showed an underlying Dacron graft consistent with an aortoenteric fistula in the third part of the duodenum. We excised the infected graft and reconstructed the abdominal aorta with a new prosthetic graft in situ, which was wrapped with the vascularized pedicle of the omentum. The duodenal defect was repaired with segmental duodenal resection and end-to-end anastomosis. The patient recovered well after surgical management and has remained in good condition for 2 years without developing any signs of recurrence of infection.