Prosthetic graft infection occurs in up to 6.0 % of patients who undergo aortic surgery
and is associated with a high mortality rate (20 – 75 %) [1 ]. Vascular-enteric fistulas (VEF) most commonly involve the third or fourth portion
of the duodenum (87 % of cases), rarely the colon (2 %) [2 ]
[3 ].
A 76-year-old man was admitted to our institution because of sepsis, most likely induced
by graft infection. The patient had received an aorto-bifemoral bypass for treatment
of an abdominal aortic aneurysm 10 months earlier. The postoperative course was characterized
by sepsis (Pseudomonas aeruginosa ). Before admission the patient reported episodes of rectorrhagia; angio-CT showed
that the left graft limb had perforated straight through the sigmoid colon. Colonoscopy
allowed the vascular stent to be located in the sigmoid colon ([Fig. 1 ], [2 ]). The proximal and distal extremities of the stent were not recognizable, since
the stent had migrated into the extraluminal compartment. Exploratory surgery was
conducted and revealed that the vascular stent had become displaced through the distal
sigmoid colon, leading to perforation of the wall. The affected part of the sigmoid
was resected together with the graft limb, with creation of a temporary Hartmann’s
diversion. We suggest performing lower gastrointestinal endoscopy early on suspicion
of VEF in patients who have had a vascular stent placed and who present recurrent
infectious episodes and low gastrointestinal bleeding of unexplained origin.
Fig. 1 Aorto-bifemoral prosthesis inside the sigmoid colon.
Fig. 2 Double-contrast colon radiograph showing the middle part of the stent inside the sigmoid
colon.
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