A rare complication of abdominal aortic reconstructive surgery: Sigmoidal necrotic mucosal prolapse. First presentation in the literature

The complications of aortic graft surgery include graft occlusion, hemorrhage, infection, pseudo aneurysm formation, aortaenteric fistula, and intestinal ischemia. We reported a rare complication of aorta bifemoral graft that caused sigmoidal mucosal ischemia. A 56-year-old man had been performed aorta bifemoral graft surgery for bilateral total iliac artery occlusion. The patient suffered from nonspecific abdominal complaints, constipation and necrotic mucosal prolapse. In physical examination, abdomen was normal but there was an approximately 20-25 cm length of necrotic mucosal tissue protruded from anal region. Colonoscopy revealed extremely narrowing of the middle of sigmoid colon and proximal rectum, their fragile and hyperemic mucosa and ulcers. Total parenteral nutrition was given within the first week after the hospitalization. The necrotic tissue was excised under local anesthesis. The patient was administered medical treatment for 20 days. No pathological finding was established in the physical examination of abdomen during the hospitalization period. Clinical, radiological, and endoscopic examinations were normal after 12 months. In conclusion; in the postoperative course of aortic graft surgery, the patients should be monitored carefully due to the probability of intestinal ischemia. Therefore, sigmoidal mucosal ischemia should be considered when necrotic mucosal prolapse and spillages were seen from anal canal after aorta-bifemoral grafting