Related Experiment Videos
[Fever and recurrent bacteremia as presentation form of secondary aortoenteric fistula]
J A Arzuaga Torre1, P Tebas Medrano, A Simal Antón
1Servicio de Medicina Interna II, Clínica Puerta de Hierro, Universidad Autónoma, Madrid.
Abstract:
Secondary aortoenteric fistula is a rare complication, although very severe, of aortic revascularization surgery. The major cause is usually infection of the prosthetic material, which may happen short or long after the intervention. The most frequent forms of presentation are digestive hemorrhage, abdominal pain or unpleasantness, shock or other symptoms associated to the compression of adjacent structures. However, as in the present case, symptoms of systemic infection may be the only manifestation, with absence of local signs. This is why a high degree of clinical suspicion is needed. The most useful complementary techniques are computerized tomography, oral endoscopy and, probably, magnetic resonance, along with gammagraphy of indium-marked leukocytes. Therapy must combine long-term systemic antibiotherapy and resection of all infected material, with reconstruction of the vascular continuity following a route far away from the infected area.
Insights
Secondary aortoenteric fistula, a severe complication of aortic revascularization, often stems from prosthetic infection. High clinical suspicion is crucial as systemic infection symptoms may be the only sign.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Gastroenterology
Background:
- Secondary aortoenteric fistula is a rare but severe complication following aortic revascularization surgery.
- Prosthetic material infection is the primary cause, occurring either shortly or long after the initial intervention.
Observation:
- Clinical presentations vary, commonly including gastrointestinal hemorrhage, abdominal pain, or shock.
- Systemic infection symptoms, without local signs, can be the sole manifestation, necessitating a high degree of clinical suspicion.
Findings:
- Diagnostic tools include computed tomography, endoscopy, magnetic resonance imaging, and indium-labeled leukocyte scintigraphy.
- Effective treatment requires a combination of long-term systemic antibiotics and surgical resection of infected prosthetic material.
Implications:
- Early recognition and prompt, aggressive management are vital for improving patient outcomes.
- Reconstruction of vascular continuity should utilize a graft placed distant from the infected site.
- Understanding atypical presentations is key for timely diagnosis and intervention in prosthetic infections.