Abstract
We report herein on a rare complication of a secondary aortoenteric fistula at the colon after reconstruction of an abdominal aortic aneurysm. A 74-year-old man had undergone Y-shaped graft replacement for an abdominal aortic aneurysm 8 years previously and an operation for a perforated gastric ulcer 2 years previously. He was admitted with melena in September 2008. Although colonoscopy identified the probable origin of the bleeding as an elevated lesion detected at the sigmoid colon, we could not obtain the patient's his family's consent for operation. He was admitted with melena again in October 2008, and this time we performed a surgical procedure with their consent. Laparotomy revealed adhesion between the sigmoid colon and the retroperitoneum. When sigmoid colon was opened, a prosthetic graft was found at the base of the granulation tissue. A secondary aortoenteric fistula was diagnosed between the anastomotic site of the right graft limb and the sigmoid colon, and removal of the contaminated right graft limb was performed. The sigmoid colon was exteriorized. The patient's ostoperative course was uneventful and he was initially discharged, but hemorrhage from a pseudoaneurysm at the anastomotic site of the right iliac artery occurred in December 2008. We thus performed a right axillobifemoral bypass and removal of the Y-shaped graft.
