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Case Reports
. 2020 Apr 7:21:e922153.
doi: 10.12659/AJCR.922153.

Aortoenteric Fistula through a Thrombosed Graft

Mahdi Malekpour  1   2 , Jeremy L Irvan  1 , Ammar Hashmi  1 , Kenneth A Widom  2 , Evan J Ryer  1
Affiliations
Case Reports

Aortoenteric Fistula through a Thrombosed Graft

Mahdi Malekpour et al. Am J Case Rep. .

Abstract

BACKGROUND Aortoenteric fistula is a dreadful and uncommon complication after abdominal aortic aneurysm repair. Continuous friction against the intestine and the aortic graft along with local inflammation is thought to be the major cause of aortoenteric fistula formation, although it is unexpected to have fistula formation with a thrombosed aortic graft. CASE REPORT Here, we report a case of an aortoenteric fistula between a thrombosed aortoiliac bypass graft and the duodenum in a 75-year-old male patient who presented with a 2-month history of melena. In this case, the aortoduodenal fistula was repaired with excision of the aortic graft, proximal and distal oversewing of the aorta, omental flap coverage, pyloric exclusion and loop gastrojejunostomy creation. CONCLUSIONS An aortoenteric fistula can form through a thrombosed graft. Since this is not an expected route of fistula formation, there may be a delay in identification.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1.
Figure 1.
Schematic presentation of previous surgeries. a) Aortoiliac bypass. b) Right axillary-bifemoral bypass. c) Site of the aortoenteric fistula.
Figure 2.
Figure 2.
Esophagogastroduodenoscopy before presentation to our center. (A) Bleeding site at fourth segment of the duodenum; D4. (B) Application of a clip at the bleeding site.
Figure 3.
Figure 3.
(A) Abdominal axial computed tomography (CT) scan with intravenous contrast demonstrating air and extravasated contrast in the duodenum (arrow). (B) Abdominal coronal CT scan with intravenous contrast in the duodenum (arrow) and in the thrombosed aortoiliac bypass graft (arrowhead). Note the loss of fat plane between the thrombosed graft and the adjacent duodenum.
Figure 4.
Figure 4.
The aortoenteric fistula is opened with evident duodenotomy (arrow) and eroded thrombosed graft (arrowhead).
See this image and copyright information in PMC

References

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