Arpit Amin*, Saptarshi Biswas, Francis Carroll, Romeo Mateo, Sateesh Babu
Department of Surgery, New York Medical College – Westchester Medical Center, Valhalla, New York, USA
Received: 01 June, 2015; Accepted: 27 November, 2015;Published: 01 December, 2015
Arpit Amin, M.D, Department of Surgery, New York Medical College – Westchester Medical Center, 100 Woods Road, Taylor Pavilion Room E173, Valhalla, New York 10595, USA, Tel: (973) 885-2591; E-mail:
Amin A, Biswas S, Carroll F, Mateo R, Babu S (2015) Celiac Arterioenteric Fistula after Open Repair of Celiac Artery Aneurysm – Case Report. Int J Vasc Surg Med 1(2): 016-020. DOI: 10.17352/2455-5452.000007
© 2015 Amin A et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
In a patient with a known history of aortic surgery, presence of upper gastrointestinal bleeding requires a high index suspicion for the possibility of aorto-enteric fistula. Aorto-enteric fistula is an uncommon but known complication occurring after abdominal aortic reconstruction. However, there are few reported cases of enteric fistulas arising after splanchnic artery aneurysm repair.
We report a unique case of a celiac artery graft – duodenal fistula in a 60-year-old male, who developed upper gastrointestinal bleeding two months after initial open resection of a celiac artery aneurysm and placement of an aorto-celiac artery graft. The patient underwent successful repair of the fistula and the resection of the involved graft with ligation of the common hepatic artery and splenectomy.
Our case report highlights the rare entity of celiac arterio-enteric fistula after open repair of a celiac artery aneurysm and reviews the diagnostic and treatment modalities available for successful management of this rare complication.
Celiac artery aneurysm was first described by Bergeon in autopsy specimens in 1830 . Celiac artery aneurysms are the 4th most common type of splanchnic artery aneurysms . Celiac artery aneurysms account for 4-6% of splanchnic artery aneurysms [2,3]. The prevalence of celiac artery aneurysm is 0.005 to 0.05% .
In the first half of the 20th century, infection (syphilis) was the major cause of celiac artery aneurysms [2,4]. During this period, majority of patients presented with symptoms secondary to rupture of celiac artery aneurysm. Advancements in diagnostic modalities and treatment options during the second half of the 20th century has significantly changed the presentation and outcome of patients with celiac artery aneurysms. Currently, atherosclerosis and medial degeneration account for the majority of celiac artery aneurysms [1-4]. With the advent of computed tomography, majority of celiac artery aneurysms are detected incidentally before they have ruptured.
In 1958, Shumacker described the first successful surgical treatment of celiac artery aneurysm . Surgical intervention in the form of ligation with or without revascularization with prosthetic graft is currently indicated for symptomatic aneurysms, aneurysms increasing in size, or aneurysms greater than 3 to 4 times the normal diameter of the celiac artery (8 mm) [3,4]. Endovascular treatment of celiac artery aneurysm with endovascular stent graft or coil embolization is an acceptable alternative in high-risk surgical patients .
Extensive experience with aortic aneurysm and its surgical repair has brought attention to the entity of aortoenteric fistula. While there are many cases of secondary aortoenteric fistulas reported in the literature, an extensive search of the literature with the terms “splanchnic artery aneurysm fistula”, “celiac artery aneurysm fistula”, “celiac artery aneurysm” and “aortoenteric fistula” revealed no case reports describing secondary arterioenteric fistulas arising after open celiac artery aneurysm repair. The extremely low incidence of celiac artery aneurysm and similarly low incidence of secondary fistula after repair of aneurysms may account for the paucity of literature on this topic. We describe a unique case of a secondary celiac arterioenteric fistula below.
A 60 year old male underwent open resection of celiac artery aneurysm with placement of prosthetic graft between the aorta and the junction of common hepatic artery and splenic artery (Figures 1a,1b). Two months after the surgery, the patient presented to our institution with 2 week history of abdominal pain, fever, and unintentional weight loss. His past medical and surgical history was significant for stent placement for bilateral common iliac artery aneurysms. Computed tomography of the abdomen revealed a fluid collection with gas bubbles in the lesser sac adjacent to the graft site raising suspicion for graft infection (Figures 2a,2b,2c).