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Case Reports
. 2019 Apr 28;5(2):78-81.
doi: 10.1016/j.jvscit.2018.12.005. eCollection 2019 Jun.

A case of aortocolonic fistula caused by sigmoid diverticulitis

Ryosuke Kowatari  1 , Hanae Sasaki  1 , Shintaro Goto  2 , Yuki Imamura  1 , Chikashi Aoki  1 , Ikuo Fukuda  1
Affiliations
Case Reports

A case of aortocolonic fistula caused by sigmoid diverticulitis

Ryosuke Kowatari et al. J Vasc Surg Cases Innov Tech. .

Abstract

The development of a secondary aortoenteric fistula is a well-described complication after open or endovascular repair of an abdominal aortic aneurysm. However, evidence regarding aortocolonic fistulas (ACFs) and their pathogenesis is currently limited. We present a case of ACF that developed 18 years after open repair of an abdominal aortic aneurysm with atypical symptoms. The patient was successfully treated with total resection of the involved aorta, prosthetic graft, and sigmoid colon, with extra-anatomic bypass and primary anastomosis of the residual colon. Pathologic examination revealed that the pathogenesis of ACF was attributed to sigmoid diverticulitis. This case report highlights the uncommon pathogenesis of ACF and the importance of considering revascularization and intestinal reconstruction in the surgical strategy for each individual case.

Keywords: Abdominal aortic aneurysm; Aortocolonic fistula; Aortoenteric fistula.

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Figures

Fig 1
Fig 1
Preoperative computed tomography showing (a) an enlarged sac around the occluded right leg of the prosthetic graft with gas bubbles surrounding the graft; (b) three high-density spots between the enlarged sac and sigmoid colon.
Fig 2
Fig 2
Schema of the presented aortocolonic fistula (ACF) showing the resection line of the aorta, prosthetic graft, and sigmoid colon (dotted line).
Fig 3
Fig 3
The resected specimen confirms the presence of three aortocolonic fistulas (ACFs) and pseudoaneurysm surrounding the site of the ruptured distal anastomosis.
Fig 4
Fig 4
Microscopic pathology. a, Low-power field showing that the demarcation line between the pseudoaneurysm and sigmoid colon was unclear because of advanced fibrosis (arrowheads). In addition, loss of intestinal smooth muscle continuity was observed near the fistulas (dotted line). b, High-power field on the intestinal side of the fistula showing granulation with marked neutrophilic infiltration. c, High-power field on the aortic side of the fistula showing the presence of substantial intestinal tract content in the aorta (arrowheads).
See this image and copyright information in PMC

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