Aorto-Enteric Graft Erosion

Aorto-Enteric Graft Erosion

Melina R. Kibbe
The University of Pittsburgh, Pittsburgh, PA

Edith Tzeng
The University of Pittsburgh, Pittsburgh, PA

Brief Case History

A 59 year-old man with a long-standing history of peripheral vascular disease presented with severe symptomatic anemia (Hct=14) and presumed GI bleeding. His past medical history was significant for a prior aortobifemoral bypass 10 years ago. This was subsequently complicated by erosion of the right limb of the graft into the cecum and was treated by local resection of the right limb of the graft and a right hemicolectomy 2 years prior to this admission. During the current admission, work-up of the severe anemia included an esophagogastro-duodenoscopy (Figure 1), which revealed a foreign body (arrow) located in the 3rd portion of the duodenum (arrow head). An abdominal CT scan demonstrated that the duodenum was adherent to the bed of the aortic graft, which itself was not visualized. An upper GI contrast study

(Figure 2) revealed the presence of a tubular foreign body (arrow) within the distal duodenal (arrow head). The patient was taken to the operating room with the presumed diagnosis of aorto-enteric erosion. Intraoperative findings (Figure 3) revealed the complete engulfment (Figure 3, panel 1) of the proximally disconnected, thrombosed bifurcated aortic graft (arrow) within the distal duodenum (arrow head). The aortic graft was removed from the duodenum (Figure 3, panels 2-3) and the distal anastomoses were taken down. The involved portion of the duodenum was resected and the GI tract was reconstructed with a duodeno-jejunostomy. The patient did well post-operatively and was discharged from the hospital tolerating a regular diet.