[Successful treatment of pseudoaneurysm of the proximal anastomosis of the aorto-bifemoral bypass graft complicated by necrosis of the sigmoid colon wall].

The article describes a case report of successful surgical management of a 58-year-old male patient presenting with a pseudoaneurysm of the proximal anastomosis of the aorto-bifemoral bypass graft complicated by necrosis of the sigmoid colon wall. The patient was operated on 11 months after the first reconstructive operation, i.e. aorto-bifemoral bypass grafting and femoropopliteal bypass grafting for Leriche's syndrome. Clinical manifestations of a false aneurysm of the proximal anastomosis (abdominal pain, presence of a pulsating tumour-like formation) appeared one month after surgery. The diagnosis was verified by ultrasonography, angiography, and CT-angiography. During the repeat operation, it was determined that a large false aneurysm of the abdominal aorta had been caused by a complete cutting through of the anastomosis's sutures more than by half of the semicircle. Intraoperative findings included both a coarse commissural process in the abdominal cavity and 3 x 3 cm "decubital" necrosis of the dolichosigmoid's wall participating in the formation of the wall of the false aneurysm. The surgical procedure consisted in an operation of aneurysmal resection, aorto-bifemoral prosthetic repair, and resection of the dolichosigmoid with the establishment of an interintestinal end-to-side anastomosis and single-barrel preventive sigmoidostoma. After 3 months, the patient was subjected to the operation of intraperitoneal closure of the sigmoidostoma followed by complete recovery.