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SECONDARY AORTOENTERIC FISTULA – AN UNCOMMON SOLUTION FOR A COMPLEX CASE
| Summary: | IntroductionSecondary aortoenteric fistula is a fearsome complication of aortic surgery due to its high morbidity and mortality. Therapeutic decision-making is mostly determined by the possibility of concomitant prosthetic infection. Case reportWe present the case of a 55 year old male patient with previous juxta-renal aortic aneurysm resection and tube graft interposition. A left kidney infarction was detected at the third post-operative month during investigation for persistent lumbar pain. The patient was admitted 14 months after the surgery with a four-month history of fever, night sweats and weight loss and. A CT angiogram revealed thickening of peri-aortic tissues and a fluid collection anteriorly to the left iliopsoas muscle. A PET scan showed increased uptake around the graft, indicating the presence of infection. The patient underwent axillobifemoral bypass and removal of the infected graft with ligation of the para-renal aorta. Revascularization of the right kidney was achieved via hepatorenal bypass with inverted great saphenous vein. A fistulous tract in the third portion of the duodenum was noted, mandating duodenectomy and Roux-en-Y gastrojejunostomy. The patient completed a three-week course of triple antibiotic and anti-fungal therapy and a further week of double antibiotic therapy, being discharged after 30 days. A CT angiogram at six weeks showed continued patency of the revascularization procedures and no intra-abdominal complications. ConclusionOpen surgery remains the most effective treatment in good-risk patients. The adoption of alternative solutions is a necessity to cope with the anatomic singularities of more complex cases. |
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| Subject: | revascularização renal graft infection renal revascularization hepatorenal bypass bypass axilo-bifemoral Aortoenteric fistula axillobifemoral bypass infecção protésica Fístula aorto-entérica bypass hepato-renal |
| Country: | Portugal |
| Document type: | journal article |
| Access type: | Restricted |
| Associated institution: | Angiologia e Cirurgia Vascular |
| Language: | English |
| Origin: | Angiologia e Cirurgia Vascular |
| _version_ | 1850560651709120512 |
|---|---|
| conditionsOfAccess_str | Copyright (c) 2017 Angiologia e Cirurgia Vascular |
| contentURL_str_mv | http://acvjournal.com/index.php/acv/article/view/59/41 http://acvjournal.com/index.php/acv/article/view/59 |
| country_str | PT |
| description | IntroductionSecondary aortoenteric fistula is a fearsome complication of aortic surgery due to its high morbidity and mortality. Therapeutic decision-making is mostly determined by the possibility of concomitant prosthetic infection. Case reportWe present the case of a 55 year old male patient with previous juxta-renal aortic aneurysm resection and tube graft interposition. A left kidney infarction was detected at the third post-operative month during investigation for persistent lumbar pain. The patient was admitted 14 months after the surgery with a four-month history of fever, night sweats and weight loss and. A CT angiogram revealed thickening of peri-aortic tissues and a fluid collection anteriorly to the left iliopsoas muscle. A PET scan showed increased uptake around the graft, indicating the presence of infection. The patient underwent axillobifemoral bypass and removal of the infected graft with ligation of the para-renal aorta. Revascularization of the right kidney was achieved via hepatorenal bypass with inverted great saphenous vein. A fistulous tract in the third portion of the duodenum was noted, mandating duodenectomy and Roux-en-Y gastrojejunostomy. The patient completed a three-week course of triple antibiotic and anti-fungal therapy and a further week of double antibiotic therapy, being discharged after 30 days. A CT angiogram at six weeks showed continued patency of the revascularization procedures and no intra-abdominal complications. ConclusionOpen surgery remains the most effective treatment in good-risk patients. The adoption of alternative solutions is a necessity to cope with the anatomic singularities of more complex cases. |
| documentTypeURL_str | http://purl.org/coar/resource_type/c_6501 |
| documentType_str | journal article |
| id | ab79ad46-f0e9-44c3-9544-31dbe60549bd |
| identifierDoi_str | https://doi.org/10.48750/acv.59 |
| language | eng |
| relatedInstitutions_str_mv | Angiologia e Cirurgia Vascular |
| resourceName_str | Angiologia e Cirurgia Vascular |
| spellingShingle | SECONDARY AORTOENTERIC FISTULA – AN UNCOMMON SOLUTION FOR A COMPLEX CASE revascularização renal graft infection renal revascularization hepatorenal bypass bypass axilo-bifemoral Aortoenteric fistula axillobifemoral bypass infecção protésica Fístula aorto-entérica bypass hepato-renal |
| title | SECONDARY AORTOENTERIC FISTULA – AN UNCOMMON SOLUTION FOR A COMPLEX CASE |
| topic | revascularização renal graft infection renal revascularization hepatorenal bypass bypass axilo-bifemoral Aortoenteric fistula axillobifemoral bypass infecção protésica Fístula aorto-entérica bypass hepato-renal |