Secondary Aortocolic Fistula: Case Report and Review of the Literature

A secondary aortoenteric fistula (SAEF) is relatively rare after abdominal aortoiliac reconstructive surgery. Most SAEFs are associated with a graft prosthesis, and rectum involvement is rarely reported. We report a rectal SAEF after aortoiliac aneurysmorrhaphy, i.e., oversewing the artery without a graft. A 62-year-old man had an appendicitis-related infected right common iliac artery aneurysm and sterile left aortoiliac arterial aneurysm. Six weeks after an appendectomy with a right iliac aneurysmectomy, left aortoiliac reduction aneurysmorrhaphy, and femorofemoral bypass grafting, he developed repeated bloody stool. Abdominal computed tomography and colonoscopy findings strongly indicated communication between the native aortic or iliac arteries and the rectal lumen. Emergency surgery-left infected aortoiliac artery excision, oversewing the aortic stump, right axillofemoral bypass, and sigmoid protectomy with an end-colostomy-was performed. Unfortunately, the aortic stump developed a pseudoaneurysm 6 weeks after the second laparotomy. During the third emergency laparotomy, more of the stump was amputated and wrapped in the omentum. At 45-month follow-up, the patient was well and without infection recurrence or leg ischemia. This case is a reminder that even patients without a graft prosthesis are at risk for SAEF after any aortoiliac surgery. We also comprehensively reviewed the English literature from 1960 to 2008 on prosthesis-free SAEF patients.