Surgical Management of Aortoenteric Erosion Due to Pulsatile Stress After Aneurysm Repair: A Case Report

Abstract

Secondary aortoenteric fistula or erosion (SAEFE), an abnormal connection between the aorta and gastrointestinal tract, is a rare but critical complication after abdominal aortic aneurysm repair. Most SAEFEs occur between the aorta or proximal graft anastomosis and the duodenum, and occurrence between the iliac graft and small intestine is rare. Standard SAEFE management involves graft removal and extra-anatomical bypass. However, this is extremely invasive and has a high mortality rate. We encountered a rare case of SAEFE with no sign of infection, which was successfully treated by ligating the iliac graft to reduce mechanical pulsatile stress and bleeding following the retroperitoneal approach.

Secondary aortoenteric fistula: a narrative review of the view of the surgeon

“…More than 50% of cases had a duration longer than 3 days [ 26 ]. This time frame can be used as an opportunity for the treatment of fistulas [ 14 ].…”

“…A recent series [10] demonstrated that SAEF continues to be a life-threatening condition, with a 27% in-hospital mortality rate, which is substantially higher upon emergency presentation, despite prompt diagnosis and treatment. The majority of fistulas involving the intestinal tract are between the aorta and the 3 rd -4 th portion of the duodenum (between the abdominal aorta and the superior mesenteric artery) in 74% of cases, followed by the small intestine (jejunum more commonly than the ileum) 19%, the colon 5%, and the appendix 1% [11][12][13][14].…”