Abstract
Aortoenteric fistula (AEF) is a rare life-threatening condition. Secondary AEF (SAEF) occurs in patients with abdominal aortic aneurysm (AAA) repair and has a high mortality rate. We present a case of a 66-year-old female who presented to the emergency room with hematochezia and hemodynamic instability. Emergent esophagogastroduodenoscopy (EGD) was negative. Colonoscopy revealed a 5 cm, pulsatile, bleeding, submucosal mass. A stat computed tomography (CT) angiogram of the abdomen and pelvis revealed a large left external iliac artery (LEIA) pseudoaneurysm. Vascular surgery emergently placed a LEIA stent. It appeared the patient had an aorto-bi-iliac (ABI) common iliac artery (CIA) bypass, 15 years ago, for a large AAA that had resulted in a SAEF, with the rare finding of communication with the colon. She had a complicated course involving surgical and medical management but with successful outcomes.
Highlights
Aortoenteric fistula (AEF) is a rare but life-threatening condition with an annual incidence of 0.007/million [1]
We present a case of a 66-year-old female who presented to the emergency room with hematochezia and hemodynamic instability
Vascular surgery emergently placed a left external iliac artery (LEIA) stent. It appeared the patient had an aorto-bi-iliac (ABI) common iliac artery (CIA) bypass, 15 years ago, for a large abdominal aortic aneurysm (AAA) that had resulted in a Secondary AEF (SAEF), with the rare finding of communication with the colon
Summary
Aortoenteric fistula (AEF) is a rare but life-threatening condition with an annual incidence of 0.007/million [1]. The LEIA stent-graft was patent, and there were some areas of mural thrombus in the stent-graft and possible trace extravasation into the pseudoaneurysm at the distal aspect of stent, the previous pseudoaneurysm with known connection to sigmoid colon, remains thrombosed, with no free retroperitoneal/intraperitoneal bleeding (Figure 5) Based on these findings, treatment of the infected limb of the ABI graft would require complete ABI graft explant with aortic ligation and extra-anatomic bypass. She returned a month later with recurrent episodes of bright red blood per rectum and passage of clots She underwent repeat CT angiography of the abdomen and pelvis, which demonstrated possible leak into the pseudoaneurysm from the distal aspect of the previously placed stent graft. She was last seen in the clinic one year after her initial presentation and was doing well with no recurrent bleeding or infections
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