A case of an aortocolic fistula occurring 27 years after aorto-femoral bypass surgery, treated successfully by surgical management

Abstract

The secondary aortoenteric fistula (AEF) is a rare but grave complication of aortic reconstructive surgery. We report herein a case of an aortocolic fistula which occurred 27 years after an aortofemoral bypass. A 69-year-old man was admitted to hospital following a sudden episode of melena. He had undergone aortofemoral bypass surgery with a prosthetic graft 27 years previously for occlusive disease of the right external iliac artery. Colonofiberscopy, CT scan, and angiography were performed, and an aortocolic fistula due to an aortic anastomotic pseudoaneurysm was diagnosed. The first-stage operation, being resection of the previously implanted graft, right hemicolectomy, and aortic stump closure were carried out with concomitant axillo-right femoral bypass. A femoro-femoral crossover bypass was performed in the second stage and the patients recovery followed uneventfully. This case constitutes the longest postoperative interval for an AEF recorded in the English literature.