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Aorto-enteric fistula presenting as multicentric osteomyelitis
Clinical Orthopaedics and Related Research
|March 1, 1978
Abstract:
A 60-year-old man treated with a prothesis for aorto-enteric fistulae developed multicentric osteomyelitis. Enteric flora were cultured from blood and bone but the diagnosis was delayed. Aorto-enteric fistulae can occur in a variety of circumstances but have become more common with the advent of reconstructive vascular surgery using prostheses. This entity frequently does not present in a dramatic way, but can be the cause of fatal bacteremia and septicemia.
Insights
Aorto-enteric fistulae, often linked to vascular surgery prostheses, can lead to delayed diagnosis of multicentric osteomyelitis. Early detection is crucial to prevent fatal bacteremia and septicemia.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Orthopedic Surgery
Background:
- Aorto-enteric fistulae (AEF) are abnormal connections between the aorta and the gastrointestinal tract.
- AEF incidence has increased with the widespread use of prosthetic materials in vascular reconstructive surgery.
- These fistulae can arise from various causes, including infection, inflammation, or surgical complications.
Observation:
- A 60-year-old male patient presented with multicentric osteomyelitis.
- The patient had a history of prosthetic repair for aorto-enteric fistulae.
- Enteric flora were identified in blood and bone cultures, indicating a deep-seated infection.
Findings:
- The diagnosis of osteomyelitis was significantly delayed despite positive cultures.
- Multicentric osteomyelitis developed as a complication in a patient with a history of AEF and prosthetic material.
- The clinical presentation of AEF can be insidious, not always dramatic.
Implications:
- Delayed diagnosis of AEF-related complications like osteomyelitis can lead to severe outcomes, including fatal bacteremia and septicemia.
- Vigilance for infectious complications is essential in patients with vascular prostheses, particularly those with a history of AEF.
- Improved diagnostic strategies and timely intervention are critical for managing AEF and its sequelae.