Multidisciplinary management of an intussuscepted ilio-mesenteric bypass causing an enteric fistula

Abstract

Acute mesenteric ischemia is a life-threatening condition that requires immediate surgical revascularization. Enteric fistulization following bypass for mesenteric ischemia is a rare complication that carries significant morbidity and mortality. This case report discusses the management of a 57-year-old man with prior acute on chronic mesenteric ischemia who presented with enteric fistulization of a right ilio-mesenteric bypass. The patient required explant of the ilio-mesenteric bypass, iliac reconstruction with right-to-left common iliac transposition, and small bowel resection. This case highlights the successful diagnosis and multidisciplinary management of this unusual, yet life-threatening complication following ilio-mesenteric bypass for acute mesenteric ischemia.

Keywords: Acute mesenteric ischemia; Enteric fistula; Postoperative complication; Retrograde ilio-mesenteric bypass.

Fig 1

Admission computed tomography (CTA) abdomen and pelvis demonstrating the intussuscepted ilio-mesenteric bypass into the duodenum (white arrow).

Fig 2

Intraoperative image of intussuscepted ileo-mesenteric bypass graft into the duodenum.

Fig 3

(A) Intraoperative image of transposed right common iliac artery (CIA) onto the left CIA with oversewn proximal right CIA (white arrow). (B) Intraoperative image of the resected fourth segment of the duodenum, the ligament of Treitz, and the proximal jejunum.