title: Aortoiliac endograft-enteric fistula due to an ingested toothpick.
abstract: Foreign body ingestion is not uncommon, but in most patients the object passes without sequelae. In very few patients, the ingested foreign objects may perforate the gastrointestinal tract, causing potentially life-threatening complications. Pointed ingested objects such as toothpicks are the most common. Vascular perforation due to toothpick ingestion has rarely been reported. We present a patient with lower gastrointestinal bleeding secondary to simultaneous perforation of the sigmoid colon and the right iliac limb of an aortobiiliac endograft by an ingested toothpick. This arterioenteric fistula was treated in two stages. First as a bridging operation, a stent graft was inserted into the ipsilateral limb of the previous aortoiliac endograft to control the bleeding. Second, the aortoiliac endograft was removed, the aorta was oversewn, and an extra-anatomic axillobifemoral bypass restored the flow to the lower limbs. The colon perforation was treated with a proximal temporary loop colostomy. To our knowledge, this the first case of aortoiliac endograft-enteric fistula after endovascular abdominal aortic aneurysm repair caused by this extraordinary mechanism.
authors.affiliation: 3rd Surgical Department, Vascular Unit, Attikon Teaching Hospital, University of Athens, Athens, Greece. andreaslazaris@hotmail.com
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Lazaris
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsapralis
authors.forename: Pavlos
authors.initials: P
authors.lastname: Patapis
authors.forename: Elias
authors.initials: E
authors.lastname: Mproutzos
authors.forename: Haralambos
authors.initials: H
authors.lastname: Tzathas
authors.forename: John D
authors.initials: JD
authors.lastname: Kakisis
authors.forename: Spyros N
authors.initials: SN
authors.lastname: Vasdekis
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D012809:Colon, Sigmoid / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D003125:Colostomy; D020878:Device Removal; D004724:Endoscopy; D005547:Foreign Bodies; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006801:Humans; D007412:Intestinal Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008297:Male; D012086:Reoperation; D012810:Sigmoid Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery