Multiorganism sepsis secondary to enteric aorto-iliac graft fistulation

A woman in her early 70s with a history of infrarenal aortic endarterectomy and aorto-bi-iliac Dacron grafting 4 years before presented with recurrent septicaemias, occasionally polymicrobial and caused by a wide variety of organisms. After treatment for her sixth bacteraemia, enteroscopy showed a small area of ulceration with synthetic graft material protruding into the distal duodenal lumen. This was followed by positron emission tomography/CT, which showed mild increase in tracer uptake in the same region localised by a previously placed haemoclip. Despite urgent vascular surgery to repair the duodenal fistulas and replace the grafts, the patient passed away. Our patient posed a diagnostic challenge due to repeated imaging studies of different modalities and routine endoscopy failing to show a source of sepsis. It is unique due to the variety of organisms cultured as a result of the enteric fistula.