Secondary aortoenteric fistula possibly associated with continuous physical stimulation: a case report and review of the literature

• Published in: Journal of medical case reports Vol. 13; no. 1; p. 61
• Main Authors: Saito, Hiroaki, Nishikawa, Yoshitaka, Akahira, Jun-Ichi, Yamaoka, Hajime, Okuzono, Toru, Sawano, Toyoaki, Tsubokura, Masaharu, Yamaya, Kazuhiro
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15-03-2019; BioMed Central; BMC
• Subjects: Abdomen; Abdominal aortic aneurysm; Aneurysm; Aneurysms; Antibiotics; Aortic aneurysm; Aortic Aneurysm, Abdominal - surgery; Aortic aneurysms; Aortoenteric fistula; Cardiac arrest; Cardiovascular diseases; Case Report; Case reports; CAT scans; Colonoscopy; Complications and side effects; Coronary vessels; Diagnostic imaging; Diverticulum; Fatal Outcome; Fistula; Fistulas; Hematemesis; Herald bleeding; Humans; Infections; Intestinal bleeding; Intestinal Fistula - diagnostic imaging; Intestinal Fistula - etiology; Male; Middle Aged; Mortality; Plastic surgery; Prostheses; Prostheses and implants; Risk factors; Shock; Surgery; Tomography; Tomography, X-Ray Computed; Vascular fistula; Vascular Fistula - diagnostic imaging; Vascular Fistula - etiology; Vascular Surgical Procedures - adverse effects; Veins & arteries; Herald bleeding; Aortoenteric fistula; Intestinal bleeding; Abdominal aortic aneurysm
• DOI: 10.1186/s13256-019-2003-1
• EISSN: 1752-1947

Secondary aortoenteric fistula is a rare but fatal complication after reconstructive surgery for an aortic aneurysm characterized by abdominal pain, fever, hematochezia, and hematemesis, and the mortality rate is high. It has been suggested that it arises due to either continuous physical stimulation or prosthesis infection during primary surgery. We describe an aortoenteric fistula following reconstructive surgery for an abdominal aortic aneurysm together with postmortem pathological findings.
A 59-year-old Japanese man who had undergone reconstructive surgery for an abdominal aortic aneurysm 20 months earlier presented with the chief complaint of hematochezia and malaise. Esophagogastroduodenoscopy and total colonoscopy revealed only colon diverticula with no bleeding. Contrast-enhanced computed tomography revealed gas within the aneurysm sac and adhesion between the replaced aortic graft and intestinal tract, suggesting a graft infection. After 18 days of antibiotic treatment, he suddenly went into a state of shock, with massive fresh bloody stool and hematemesis, followed by cardiac arrest. An autopsy revealed communication between the artery and the ileum through an ulcerative fistula at the suture line between the left aortic graft branch and the left common iliac artery. Pathological analysis revealed tight adherence between the arterial and intestinal walls, but no marked sign of infection around the fistula, suggesting that the fistula had arisen due to physical stimuli.
Pathological analysis suggested that the present secondary aortoenteric fistula arose due to physical stimuli. This reaffirms the importance of keeping reconstructed aortas isolated from the intestine after abdominal aortic aneurysm surgery.