Sigmoid Perforation Caused by an Aortobifemoral Vascular Graft

Abstract

An 83-year-old man underwent aortobifemoral bypass graft surgery for an abdominal aortic aneurysm. Ten days after his discharge he was readmitted with fever and signs of infection. A computed tomography scan revealed sigmoid diverticulosis, a perigraft collection containing gas bubbles near the aortic anastomosis and smaller localized collections near the iliac vessels. He was started on antibiotics but a day later he developed hematochezia. A sigmoidoscopy was performed, which revealed a prosthetic vascular graft penetrating “through and through” the sigmoid colon (Figures A–C) with active bleeding at 1 site of the perforation (Figure D, arrow). The patient underwent a partial left colectomy of the involved sigmoid with a primary anastomosis, and explantation and replacement of the aortobifemoral graft. Postoperatively, he was transferred to the intensive care unit but unfortunately died 10 days later because of septic complications.