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Journal of Medical Case Reports
Published in: Journal of Medical Case Reports 1/2019

Open Access 01-12-2019 | Tarry Feces | Case report

Secondary aortoenteric fistula possibly associated with continuous physical stimulation: a case report and review of the literature

Authors: Hiroaki Saito, Yoshitaka Nishikawa, Jun-ichi Akahira, Hajime Yamaoka, Toru Okuzono, Toyoaki Sawano, Masaharu Tsubokura, Kazuhiro Yamaya

Published in: Journal of Medical Case Reports | Issue 1/2019

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Abstract

Background

Secondary aortoenteric fistula is a rare but fatal complication after reconstructive surgery for an aortic aneurysm characterized by abdominal pain, fever, hematochezia, and hematemesis, and the mortality rate is high. It has been suggested that it arises due to either continuous physical stimulation or prosthesis infection during primary surgery. We describe an aortoenteric fistula following reconstructive surgery for an abdominal aortic aneurysm together with postmortem pathological findings.

Case presentation

A 59-year-old Japanese man who had undergone reconstructive surgery for an abdominal aortic aneurysm 20 months earlier presented with the chief complaint of hematochezia and malaise. Esophagogastroduodenoscopy and total colonoscopy revealed only colon diverticula with no bleeding. Contrast-enhanced computed tomography revealed gas within the aneurysm sac and adhesion between the replaced aortic graft and intestinal tract, suggesting a graft infection. After 18 days of antibiotic treatment, he suddenly went into a state of shock, with massive fresh bloody stool and hematemesis, followed by cardiac arrest. An autopsy revealed communication between the artery and the ileum through an ulcerative fistula at the suture line between the left aortic graft branch and the left common iliac artery. Pathological analysis revealed tight adherence between the arterial and intestinal walls, but no marked sign of infection around the fistula, suggesting that the fistula had arisen due to physical stimuli.

Conclusions

Pathological analysis suggested that the present secondary aortoenteric fistula arose due to physical stimuli. This reaffirms the importance of keeping reconstructed aortas isolated from the intestine after abdominal aortic aneurysm surgery.
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Metadata
Title
Secondary aortoenteric fistula possibly associated with continuous physical stimulation: a case report and review of the literature
Authors
Hiroaki Saito
Yoshitaka Nishikawa
Jun-ichi Akahira
Hajime Yamaoka
Toru Okuzono
Toyoaki Sawano
Masaharu Tsubokura
Kazuhiro Yamaya
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2019
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-019-2003-1

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