A Case of Graft-enteric Erosion Treated with Preceding Infection Control Followed by Elective Graft Reconstruction

Abstract

Although the usual manifestation of secondary aorto-enteric fistula (sAEF) are gastrointestinal bleeding, it is difficult to suspect sAEF in the cases without any signs of hemorrhage. A 66-year-old man was admitted to our hospital with fever. He had undergone aortobifemoral bypass for aortoiliac occlusive disease 5 years ago. Enhanced computed tomographic scan revealed accumulation of perigraft fluid and gas without pseudoaneurysm formation. Gastroduodenoscopy revealed that a bile-stained aortic prosthesis was exposed into the third portion of the duodenal lumen. Fecal occult blood test was positive. We made a diagnosis of sAEF. Because the patient was hemodynamically stable without any signs of bleedings, infection control using an antibiotics was conducted in preference to surgery. We, then, performed partial duodenectomy, debridement, partial graft replacement with a rifampicin-soaked graft, and omentopexy 2 weeks later. We report a rare case of graft-enteric erosion which characterized by erosion of the gastrointestinal tract by an underlying prosthesis but absence of a true fistulous communication with the aortic lumen, and treated with elective graft replacement after an infection control.