A CASE OF AN AORTOCOLIC FISTULA OCCURRING 27 YEARS AFTER AORTOFEMORALBYPASS-SURGERY, TREATED SUCCESSFULLY BY SURGICAL-MANAGEMENT

The secondary aortoenteric fistula (AEF) is a rare but grave complicat ion of aortic reconstructive surgery. We report herein a case of an ao rtocolic fistula which occurred 27 years after an aortofemoral bypass. A 69-year-old man was admitted to hospital following a sudden episode of melena. He had undergone aortofemoral bypass surgery with a prosth etic graft 27 years previously for occlusive disease of the right exte rnal iliac artery. Colonofiberscopy, CT scan, and angiography were per formed, and an aortocolic fistula due to an aortic anastomotic pseudoa neurysm was diagnosed. The first-stage operation, being resection of t he previously implanted graft, right hemicolectomy, and aortic stump c losure were carried out with concomitant axillo-right femoral bypass. A femoro-femoral crossover bypass was performed in the second stage an d the patients recovery followed uneventfully. This case constitutes t he longest postoperative interval for an AEF recorded in the English l iterature.