title: Aortoduodenal fistula and streptococcal myonecrosis.
abstract: Pyomyositis is a rare primary bacterial infection of the skeletal muscles. Pyomyonecrosis is the most severe manifestation of this disease and is associated with a potentially devastating outcome. Patients with peripheral vascular disease presenting with pyomyositis may be difficult to distinguish from those with critical ischemia or synthetic graft sepsis. This article reports on a patient with aortobifemoral bypass graft and severe vitamin B(12) deficiency who developed pyomyonecrosis and aortoduodenal fistula. This article highlights the etiologic dilemma, diagnostic difficulties, and management challenges inherent in such cases. Pitfalls in our management of this patient are discussed.
authors.affiliation: Department of General Surgery, Huddersfield Royal Infirmary, Huddersfield, England. aymonrazeq@yahoo.co.uk
authors.forename: Ayman S
authors.initials: AS
authors.lastname: Abdelrazeq
authors.forename: Anwar E
authors.initials: AE
authors.lastname: Owais
authors.forename: Firas
authors.initials: F
authors.lastname: Mukdad
authors.forename: Munther I
authors.initials: MI
authors.lastname: Aldoori
mesh_terms: D001018:Aortic Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D004378:Duodenal Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000601:surgery; D052880:Pyomyositis / Q000209:etiology* / Q000382:microbiology / Q000473:pathology / Q000628:therapy; D034365:Streptococcus constellatus / Q000302:isolation & purification*; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D014806:Vitamin B 12 Deficiency / Q000150:complications* / Q000188:drug therapy