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Infected Dacron mesorenal portosystemic shunt
Archives of Surgery (Chicago, Ill. : 1960)
|January 1, 1980
Summary
A patient developed severe sepsis from a contaminated Dacron shunt used for bleeding esophageal varices. Surgical removal of the shunt cured the infection, highlighting unique diagnostic challenges in portal-systemic shunts.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Innovation
Background:
- Bleeding esophageal varices are a serious complication of portal hypertension.
- Mesorenal shunts are used to decompress the portal system and control variceal bleeding.
- Prosthetic materials in vascular surgery can be susceptible to infection.
Observation:
- A patient presented with persistent, antibiotic-refractory septicemia two years after Dacron mesorenal shunt placement.
- Initial investigations, including imaging, showed a patent shunt without thrombus or aneurysm.
- The source of sepsis was eventually identified during surgery as contamination from a jejunal perforation.
Findings:
- Infectious complications of portal-systemic shunts differ from arterial prostheses, often lacking thrombosis or aneurysm.
- Contamination from adjacent gastrointestinal structures can lead to delayed-onset shunt infection.
- Surgical excision of the infected shunt was curative.
Implications:
- Diagnosis of infected portal-systemic shunts may require surgical exploration when non-invasive methods are inconclusive.
- Physicians should consider prosthetic graft infection in patients with unexplained sepsis after shunt placement.
- Early recognition and management are crucial for favorable outcomes in prosthetic graft infections.