Abstract
A 70-year-old man had undergone at age 69 prosthetic graft replacement for an infected abdominal aortic aneurysm. Eight months after discharge, he was readmitted because of anemia and loss of consciousness. Gastrointestinal endoscopy showed no abnormalities. On the fifth day after admission, he suddenly developed melena. Since emergency computed tomography revealed a pseudoaneurysm at the distal site of prosthetic graft anastomosis and the presence of gas in the aneurysmal sac, he was admitted to our center. Graft-enteric fistula was diagnosed and he underwent an emergency operation. Since he was in shock, the left axillary artery was exposed first, and an aortic occlusion balloon catheter was inserted into the descending aorta. Laparotomy revealed disruption of the distal anastomosis with pseudoaneurysm formation and fistulation into the duodenum. We performed left axillobifemoral bypass, prosthetic graft removal with omental filling, and finally fistulectomy with duodenojejunostomy. After surgery, cultures of blood and perigraft abscess fluid revealed methycillin resistant Staphylococcus aureus, and vancomycin hydrochloride was administered. His subsequent course was uneventful, and 1 month later, he was discharged. Although this patient was in shock on admission, he was successfully treated by controlling bleeding using an aortic occlusion balloon catheter, performing extra-anatomic bypass and omental filling, and effective antibiotic administration after surgery.
