Laparoscopic management of aortofemoral graft erosion into the sigmoid colon following secondary aortoenteric fistula: a case report.

Secondary aortoenteric fistula is a rare and life-threatening complication following aortic reconstructive surgery, most commonly involving the duodenum. Erosion of an aortofemoral bypass graft into the sigmoid colon is exceptionally uncommon; all reported cases were managed via open surgery with significant morbidity. Laparoscopic management with graft preservation has not been documented. A 59-year-old man presented with massive hematochezia 9 months after bilateral aortobifemoral bypass for an abdominal aortic and common iliac aneurysm. Colonoscopy revealed a vascular graft 25 cm from the anal verge. Computed tomography confirmed penetration of the graft into the sigmoid lumen without abscess or contrast extravasation. The patient underwent laparoscopic sigmoid colectomy with graft preservation and peritoneal coverage, followed by colorectal anastomosis and defunctioning ileostomy. He was discharged on postoperative Day 7. He was maintained on a 6-week course of targeted oral antimicrobial therapy. At 6-month follow-up, the patient remains well with a patent graft, no recurrent bleeding, and no graft-related complications. This case highlights the feasibility of minimally invasive management and selective graft preservation in carefully selected patients, challenging the paradigm of mandatory graft excision.