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Aortoduodenal fistula and streptococcal myonecrosis

Ayman S Abdelrazeq1, Anwar E Owais, Firas Mukdad

  • 1Department of General Surgery, Huddersfield Royal Infirmary, Huddersfield, England. aymonrazeq@yahoo.co.uk

Vascular and Endovascular Surgery
|August 1, 2008
PubMed

Insights

Pyomyonecrosis, a severe bacterial muscle infection, poses diagnostic challenges, especially in patients with peripheral vascular disease and bypass grafts. This case highlights a rare presentation with aortoduodenal fistula and vitamin B12 deficiency.

Area of Science:

  • Infectious Diseases
  • Vascular Surgery
  • Gastroenterology

Background:

  • Pyomyositis is a bacterial skeletal muscle infection; pyomyonecrosis is its severe form.
  • Peripheral vascular disease complicates pyomyositis diagnosis, mimicking critical ischemia or graft infection.
  • Vitamin B12 deficiency is a potential, though unusual, contributing factor in severe infections.

Observation:

  • A patient with an aortobifemoral bypass graft presented with symptoms suggestive of infection.
  • The patient also had a severe vitamin B12 deficiency.
  • Pyomyonecrosis and an aortoduodenal fistula were diagnosed.

Findings:

  • The co-occurrence of pyomyonecrosis, aortobifemoral bypass graft, and aortoduodenal fistula presented a complex clinical scenario.
  • Distinguishing pyomyonecrosis from synthetic graft sepsis in patients with peripheral vascular disease is challenging.
  • Severe vitamin B12 deficiency may play a role in the pathogenesis or severity of such infections.

Implications:

  • This case underscores the need for a high index of suspicion for rare complications like aortoduodenal fistula in patients with bypass grafts and severe infections.
  • Multidisciplinary management is crucial for addressing the complex interplay of vascular disease, infection, and nutritional deficiencies.
  • Understanding diagnostic and therapeutic pitfalls is essential for improving outcomes in similar complex cases.

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