Aortoenteric Fistula: An Uncommon but Life-Threatening Complication of Pledget Use in Hiatal Hernia Repair

The standard treatment for hiatal hernia repair and gastroesophageal reflux disease (GERD) is laparoscopic Nissen fundoplication, in which a Teflon pledget (TP) is used to buttress the hiatal hernia. We present an extremely rare case in which a 74-year-old female developed a postoperative aortoenteric fistula due to erosion of a TP used during paraesophageal hernia repair. A computed tomography (CT) angiogram and esophagogastroduodenoscopy (EGD) confirmed the diagnosis. Subsequently, a thoracic endovascular aortic repair (TEVAR) was performed to treat the aortoenteric fistula, and the TP was removed using a raptor grasping device and scissors during a repeat EGD at a tertiary care center. In this article, we discuss different causes of TP erosion and possible countermeasures that may help prevent such complications.