A rare case presenting with rectal bleeding: Iatrogenic transcolonic graft malposition

Aortobifemoral bypass surgery is commonly performed for aortoiliac occlusive disease. Aortoenteric fistula (AEF) is a rare but serious complication, either primary or secondary. This case report presents a 50-year-old male who developed hematochezia three months after aortobifemoral bypass. Colonoscopy revealed an iatrogenic sigmoid colon injury. The patient required multidisciplinary management involving general surgery and urology. He underwent multiple reoperations, including bowel repair, ureteral intervention, and colostomy. Postoperative care included antibiotics and dual antiplatelet therapy. He was discharged in stable condition after 35 days, with no further gastrointestinal bleeding observed during follow-up. This case highlights the need to consider secondary AEF in post-vascular surgery patients presenting with GI bleeding. Prompt diagnosis and coordinated multispecialty intervention are crucial to prevent fatal outcomes and ensure optimal recovery.