Primary aortoenteric fistula due to septic aortitis.
Primary aortoenteric fistula is most commonly caused from erosion of the bowel wall by an abdominal aortic aneurysm. Septic aortitis with pseudoaneurysm formation and finally erosion into the duodenum represents a rare cause that has been described in very few patients in the literature. We present a rare clinical case of Salmonella aortitis and associated infrarenal aortic pseudoaneurysm that evolved into an aortoduodenal fistula. A 51-year-old man was admitted in our hospital with symptoms and signs of sepsis caused by Salmonella bacteremia. Imaging studies revealed an infrarenal aortic pseudoaneurysm. The patient presented hemodynamic instability, and during emergency laparotomy a fistula was found between the third portion of the duodenum and a false aneurysm arising from a nonaneurysmal grossly infected aorta. The affected aortic segment was excised and the intestinal defect was repaired. The aortic stumps were sutured and an axillobifemoral bypass was performed. The patient had an uncomplicated postoperative course.
Skourtis
Georgios
G
Department of Vascular Surgery, KAT General Hospital, Athens, Greece. skourtisgeo@in.gr
Papacharalambous
Gerasimos
G
Gerasimos
Papacharalambous
P
Makris
Sotirios
S
Sotirios
Makris
M
Kasfikis
Fotios
F
Fotios
Kasfikis
K
Kastrisios
Georgios
G
Georgios
Kastrisios
K
Goulas
Sotirios
S
Sotirios
Goulas
G
Antoniou
Ioannis
I
Ioannis
Antoniou
A
Giannakakis
Sotirios
S
Sotirios
Giannakakis
G
Maltezos
Chrisostomos
C
Chrisostomos
Maltezos
M
D017541:Aneurysm, False / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery; D000785:Aneurysm, Infected / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D015901:Angiography, Digital Subtraction; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery; D001025:Aortitis / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery; D001027:Aortography / Q000379:methods; D013505:Digestive System Surgical Procedures; D004378:Duodenal Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D012480:Salmonella Infections / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery; D014656:Vascular Surgical Procedures
D000900:Anti-Bacterial Agents