[Aortoenteric fistula secondary to aortobifemoral prosthesis infection].
We present the case of a 76 year-old man, intervened of an obstruction bilateral iliac by means of placement of a prosthesis aortobifemoral that presented pain in the grave left iliac and fever in needles of 39 degrees C to the five years of the intervention. In the physical exploration it highlighted a painful abdomen in the grave left iliac with signs of peritoneal irritation. In the laboratory tests a leukocytosis was detected with neutrophilia and negative culture. The computed thomography (CT) show the presence of gas bubbles around the prosthesis, as well as a liquid collection with areas necrotics in their interior that affected to the psoas and iliac muscles. In the same exploration the aspirative puncture with drainage of the absces demonstrated in the cultivations carried out in aerobic means the presence of Enterococcus faecalis and Enterobacter cloacae. When presenting a high gastrointestinal hemorrhage abruptly, he was practiced and gastroduodenal endoscope in which a aortoduodenal fistula was evidenced with having bled active. When a bypass extra-anatomic, the sick person will practice it died when presenting a shock abrupt hipovolemic that he didn't respond to the pertinent treatment. We analyze the approaches current diagnoses of infection of the vascular prosthesis and their more serious complication, the aortoenteric fistula (AEF) that either appears in the 0.3-5.9% of the patients who undergo prosthetic reconstruction of the abdominal aorta, for occlusive or aneurismal disease. We highlight the importance of carrying out a precocious diagnosis of the infection of the portion retroperitoneal of the vascular graft that, often, it is manifested with subtle and not specific clinical signs, with the techniques at the moment available as: the CT, fine needle aspiration guided by her, and to diminish the rates of mortality, from the current of 43%, until the most optimistic estimated in 19%.
Gabriel Botella
F
F
Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia.
Labiós Gómez
M
M
Ibáñez Gadea
L
L
Fácila Rubio
L
L
Carbonell Cantí
C
C
D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D001018:Aortic Diseases / Q000209:etiology*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D004378:Duodenal Diseases / Q000209:etiology*; D016983:Enterococcus; D005268:Femoral Vein / Q000601:surgery*; D016908:Gram-Positive Bacterial Infections / Q000150:complications*; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology*; D008297:Male; D016459:Prosthesis-Related Infections / Q000150:complications*; D016157:Vascular Fistula / Q000209:etiology*