In situ repair of a secondary aortoappendiceal fistula with a rifampin-bonded dacron graft

Secondary aortoenteric fistulas remain challenging diagnostic and therapeut ic problems. Although the duodenum is most frequently involved, other intes tinal segments are possible sites for fistulization. We report here a case of graft-appendiceal fistula revealed by recurrent gastrointestinal bleedin g 11 years after abdominal aortic aneurysm replacement. The preoperative di agnosis was not achieved by endoscopy or imaging assessment. Despite recomm ended principles of total graft excision and extraanatomic bypass, appendec tomy and in situ rifampin-bonded graft reconstruction were performed becaus e of the advanced age and poor arterial runoff. The postoperative course wa s uneventful and the patient remains well 17 months after operation.