Migration of the ringed ePTFE graft into the small intestine

Abstract

A 78-year-old man who underwent coronary artery bypass surgery and mesenteric artery bypass surgery 6 months previously presented with a groin swelling. Occlusion of the celiac artery and severe stenosis of the superior and inferior mesenteric arteries had been detected before the coronary bypass. Two days after the coronary bypass, sudden bowel ischemia occurred. The visceral organs appeared to be free of necrotic changes, but the bowel was pale. As the patient needed immediate reperfusion of the bowel, we selected an artificial graft and chose to perform bypass grafting from the femoral artery to the superior mesenteric artery through the intraperitoneal free space. Therefore, emergency bypass surgery from the femoral artery to the superior mesenteric artery using a ringed expanded polytetrafluoroethylene graft (ePTFE) was performed (A/Cover). When the patient was admitted to our hospital 6 months after the operation, his left groin was swollen, and he had a low-grade fever. His appetite was very good, and there were no symptoms of panperitonitis. Emergency computed tomography revealed the occlusion of the ePTFE graft, air in the graft, and the migration of the graft into the small intestine (B and C) Cultures from the left groin grew Torulopsis glabrata and Escherichia coli, but blood cultures were negative. An urgent graft excision was performed. The graft was severely adhered to the sigmoid colon, and the body of the graft had perforated the small intestine (D). We removed the graft from the small intestine and found that it was filled with pus. After graft excision, the defects at the anastomotic site were patched with saphenous vein. Cultures of the artificial graft grew E. coli and Enterococcus faecalis. Antibiotics were administered for 2 weeks, and the infection was controlled well. This is a very rare case of the migration of an artificial graft into the small intestine. This case shows that bypass grafting from the femoral artery to the mesenteric artery through the intraperitoneal free space may cause the adhesion of the graft to the bowel and induce the perforation of the small intestine, and grafts should ideally be fixed to the retropertioneum.