Entero-Articular Fistula Following Total Hip Arthroplasty in a Patient Post Pelvic Exenteration.

Abstract

Entero-articular fistulas are rare but serious complications following total hip arthroplasty (THA), often associated with prior abdominal or pelvic surgery, radiation therapy, or chronic steroid use. We report a case of a 65-year-old woman with metastatic ovarian cancer previously treated with pelvic exenteration and heated intra-peritoneal chemotherapy (HIPEC), who developed an entero-articular fistula following THA for avascular necrosis (AVN). Post-operatively, she presented with systemic signs of infection and polymicrobial joint cultures containing enteric organisms, raising suspicion for bowel communication. Imaging revealed gas tracking from the pelvis to the hip joint, and subsequent surgery confirmed a fistulous connection with the small bowel adherent to the pelvic wall and protrusion of the allograft into the bowel. Management involved bowel resection, mesh placement, multiple joint washouts and prolonged antimicrobial therapy. This case highlights the diagnostic challenges of entero-articular fistulas, particularly in patients with complex surgical histories and underscores the importance of a multidisciplinary approach for effective diagnosis and management.