[A case of successfully resected abdominal aortic aneurysm complicated by arteriocolic fistula]

A 80 year-old man was admitted to our hospital with profuse rectal bleeding. Two weeks prior to admission he was diagnosed as having abdominal aortic aneurysm when he had first herald of rectal bleeding. Aortoenteric fistula was strongly suspected and patient underwent emergency operation. Bilateral axillofemoral bypass were first constructed in order to avoid contamination in hte peritoneal cavity. On laparotomy aneurysm was contaminated because of arteriocolic fistula and resection of aortoiliac aneurysm and Hartmann procedure were performed. In the postoperative course, formation of an intra-abdominal abscess, obstruction of the left axillo-femoral bypass graft and enlargement of a residual aneurysm occurred. The prolonged antibiotic therapy was successful and additional repair operations were performed. Abdominal aortic aneurysm complicated with arteriocolic fistula is a rare but lethal disease. To our knowledge, only 13 cases have been reported in the literature including our case. Eleven patients were operated but only 3 survived. Construction of an extra-anatomic bypass, avoidance of an anastomosis in unprepared bowel and aggressive use of antibiotics are recommended because fecal contamination to the aneurysm is inevitable in most cases.