scholarly journals Fatal Case of a Contained Ruptured of the Infrarenal Aorta due to Simultaneous Primary Aortocaval Fistula and Aortoenteric Fistula

2021 ◽  
Author(s):  
Abdulhakim Ibrahim ◽  
Elena Marchiori ◽  
Alexander Oberhuber ◽  
Marco V. Usai
Keyword(s):  
Psoas Abscess ◽  
Aortic Rupture ◽  
Fatal Case ◽  
Aortoenteric Fistula ◽  
Infrarenal Aorta ◽  
Aortocaval Fistula ◽  
Antibiotic Management ◽  
Extensive Debridement ◽  
Crossover Bypass ◽  
Aortic Anastomosis

AbstractWe report an extremely rare case of primary aortocaval fistula with simultaneous development of an aortoenteric fistula in a 68-year-old man. The patient developed under oral anticoagulation a spontaneous intracaval aortic rupture. An emergency intervention was performed with a covering of the fistula with an aorto-uniiliac stent graft and a femoro-femoral crossover bypass. One week later, the patient was transferred to our institution with the diagnosis of a psoas abscess and a suspected concomitant aortoenteric fistula. We performed a complete explantation of the endograft and implanted it after extensive debridement an aortobiiliac bypass, made of bovine pericardium. The postoperative course was complicated, first by bleeding from the left iliac anastomosis, and then by bleeding from the proximal aortic anastomosis. The entire graft was explanted and an axillo-femoral bypass was implanted. The patient then developed a multi-organ failure and died 3 months later. If possible, an extended surgical debridement and resection of all infected tissue with in situ reconstruction is the gold standard. However, with this therapy, there is still a high risk of reinfection. Long-term antibiotic management is mandatory.

scholarly journals A Rare Cause of Necrotizing Fasciitis: Psoas Abscess

2005 ◽  
Vol 12 (4) ◽  
pp. 242-245
Author(s):  
AYC Siu ◽  
SL Kwok ◽  
CH Chung ◽  
KK Lai
Keyword(s):  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Soft Tissue Infection ◽  
Psoas Abscess ◽  
Fatal Case ◽  
Tissue Infection ◽  
Mortality And Morbidity ◽  
Group A ◽  
Clinical Tools ◽  
Very High

Necrotizing fasciitis always carries very high mortality and morbidity rates. It can be due to group A beta-haemolytic streptococci, which are traditionally described as the flesh-eating bacteria. More commonly, it is related to a mixed growth of bacteria that can be secondary to trauma or surgery. Secondary necrotizing fasciitis due to concomitant soft tissue infection is uncommon. We reported a fatal case of necrotizing fasciitis which was caused by a coexisting psoas abscess. A search for concomitant soft tissue infection is warranted in patients presenting with necrotizing fasciitis. This article also reviewed the clinical tools that may help to make an early diagnosis of the disease.

scholarly journals A clampless and sutureless aortic anastomosis technique using an endograft connector for aortoiliac occlusive disease in which the aorta cannot be clamped or sewn due to calcification or scarring

Vascular ◽  
2012 ◽  
Vol 20 (5) ◽  
pp. 262-267 ◽  
Author(s):  
Dimitrios Papadimitriou ◽  
Dieter Mayer ◽  
Mario Lachat ◽  
Felice Pecoraro ◽  
Thomas Frauenfelder ◽  
...  
Keyword(s):  
Stent Graft ◽  
Iliac Artery ◽  
Bypass Surgery ◽  
External Iliac Artery ◽  
Occlusive Disease ◽  
Infrarenal Aorta ◽  
Aortoiliac Occlusive Disease ◽  
First Case ◽  
Aortic Anastomosis

Bypass surgery in aortoiliac or aortofemoral occlusive disease can be technically demanding and hazardous due to huge calcifications and/or patient co-morbidities. We report about mid-term results of a telescoping sutureless aortic anastomosis technique using endografts as connectors to address such challenging situations. This is a single-center experience (2004–2011) in seven patients (63 ± 6 years) requiring aortoiliac (three) or aortofemoral (four) bypass surgery. In six cases, an aortic stent graft was telescoped into the infrarenal aorta and partly deployed within the aorta and partly outside the aorta. In the first case, a bifurcated stent graft was deployed and the iliac legs were prolonged extra-anatomically with surgical grafts to reach the femoral bifurcation. In the following five cases, a tapered tubular stent graft was deployed through the aortic wall, landing inside a bifurcated surgical graft that was extra-anatomically connected to the iliac or femoral arteries. In the last case, which presented a hostile abdomen and high-risk for extensive surgery, a similar technique was used, but on the iliac artery level. In that case, an iliac stent graft re-loaded ‘upside down’ was deployed through the left common iliac wall, landing distally inside a hand-made 10 × 10 mm bifurcated surgical graft that was extra-anatomically connected to the left external iliac artery and to the right femoral artery. The distal anastomoses on the seven cases were performed either with running sutures (ten) or with VORTEC (four). Telescoping aortic and/or iliac anastomosis was successful in all patients. There was no perioperative mortality. One patient developed postoperative hyperperfusion of the left leg and necessitated fasciotomy. During a mean follow-up of 1.8 ± 2 years (minimum: 270 days, maximum: 7.1 years), all of the grafts remained patent and there was neither stent-graft migration nor stenosis on the level of the aortic or iliofemoral connection. One patient showed disease progression and required percutaneous transluminal angioplasty on the external iliac artery during follow-up. The uneventful perioperative course in these seven patients, with a follow-up of up to six years, underscores that this new technique can be considered in patients with aortoiliac or aortofemoral occlusive disease and in whom clamping and/or anastomosis is expected to be cumbersome or impossible.

A Fatal Case of Occult Aortoenteric Fistula

2018 ◽  
Vol 113 (Supplement) ◽  
pp. S1137-S1138
Author(s):  
Kimesh Chetty ◽  
Erik Vantomme ◽  
Mike OʼByrne
Keyword(s):  
Fatal Case ◽  
Aortoenteric Fistula

scholarly journals A Fatal Case of Multidrug ResistantAcinetobacterNecrotizing Fasciitis: The Changing Scary Face of Nosocomial Infection

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Nupur Sinha ◽  
Masooma Niazi ◽  
Dmitry Lvovsky
Keyword(s):  
Necrotizing Fasciitis ◽  
Early Recognition ◽  
Fatal Case ◽  
Trauma Surgery ◽  
Severe Trauma ◽  
Multidrug Resistant ◽  
High Morbidity ◽  
History Of ◽  
Extensive Debridement ◽  
Operative Findings

Necrotizing fasciitis is an uncommon soft-tissue infection, associated with high morbidity and mortality. Early recognition and treatment are crucial for survival.Acinetobacter baumanniiis rarely associated with necrotizing fasciitis. Wound infections due toA. baumanniihave been described in association with severe trauma in soldiers. There are only sporadic reports of monomicrobialA. baumanniinecrotizing fasciitis. We report a unique case of monomicrobial necrotizing fasciitis caused by multidrug resistant (MDR)A. baumannii, in absence of any preceding trauma, surgery, or any obvious breech in the continuity of skin or mucosa. A 48-year-old woman with history of HIV, asthma, hypertension, and tobacco and excocaine use presented with acute respiratory failure requiring mechanical ventilation. She was treated for pneumonia for 7 days and was successfully extubated. All septic work-up was negative. Two days later, she developed rapidly spreading nonblanching edema with bleb formation at the lateral aspect of right thigh. Emergent extensive debridement and fasciotomy were performed. Operative findings and histopathology were consistent with necrotizing fasciitis. Despite extensive debridement, she succumbed to septic shock in the next few hours. Blood, wound, and tissue cultures grewA. baumannii, sensitive only to amikacin and polymyxin. Histopathology was consistent with necrotizing fasciitis.

Das rupturierte infrarenale Aortenaneurysma – eine kritische Analyse

VASA ◽  
1999 ◽  
Vol 28 (1) ◽  
pp. 30-33 ◽  
Author(s):  
Bürger ◽  
Meyer ◽  
Tautenhahn ◽  
Halloul
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Rupture ◽  
Anesthetic Management ◽  
Objective Evaluation ◽  
Left Ventricular ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Infrarenal Aortic Aneurysm ◽  
Emergency Situations ◽  
Probability Of Death

Background: Objective evaluation of the management of patients with ruptured infrarenal aortic aneurysm in emergency situations has been described rarely. Patients and methods: Fifty-two consecutive patients with ruptured infrarenal aortic aneurysm (mean age, 70.3 years; range, 56–89 years; SD 7.8) were admitted between January 1993 and March 1998. Emergency protocols, final reports, and follow-up data were analyzed retrospectively. APACHE II scores at admission and fifth postoperative day were assessed. Results: The time between the appearance of first symptoms and the referral of patients to the hospital was more than 5 hours in 37 patients (71%). Thirty-eight patients (71%) had signs of shock at time of admission. Ultrasound was performed in 81% of patients as the first diagnostic procedure. The most frequent site of aortic rupture was the left retroperitoneum (87%). Intraoperatively, acute left ventricular failure occurred in four patients, and cardiac arrest in two others. The postoperative course was complicated significantly in 34 patients. The overall mortality rate was 36.5% (n = 19). In 35 patients, APACHE II score was assessed, showing a probability of death of more than 40% in five patients and lower than 30% in 17 others. No patient showing probability of death of above 75% at the fifth postoperative day survived (n = 7). Conclusions: Ruptured aortic aneurysm demands surgical intervention. Clinical outcome is also influenced by preclinical and anesthetic management. The severity of disease as well as the patient’s prognosis can be approximated using APACHE II score. Treatment results of heterogenous patient groups can be compared.

Blood will find its way. Retrograde perfusion of a transplant- kidney via a femoro- femoral crossover bypass

VASA ◽  
2013 ◽  
Vol 42 (6) ◽  
pp. 453-456 ◽  
Author(s):  
Jurgen Knuth ◽  
Dirk Wenzel ◽  
Axel Goßmann ◽  
Marko Aleksic
Keyword(s):  
Retrograde Perfusion ◽  
Transplant Kidney ◽  
Crossover Bypass

Secondary aortoenteric fistula: 3 case reports and review

2009 ◽  
Vol 47 (05) ◽  
Author(s):  
P Sarlós ◽  
P Acél ◽  
C Csizmadia ◽  
A Illés ◽  
Á Király ◽  
...  
Keyword(s):  
Case Reports ◽  
Aortoenteric Fistula

Iatrogenic thoracic aortic injury in esophagectomy – a case report and literature review

2019 ◽  
Vol 98 (6) ◽  
pp. 256-259
Keyword(s):  
Case Report ◽  
Minimally Invasive ◽  
Thoracic Aorta ◽  
Aortic Rupture ◽  
Hypovolemic Shock ◽  
Left Lung ◽  
Aortic Injury ◽  
Thoracoscopic Esophagectomy ◽  
Neoadjuvant Radiochemotherapy ◽  
Thoracic Aortic Injury

Introduction: This case report describes bleeding from an iatrogenic thoracic aortic injury in minimally invasive thoracoscopic esophagectomy. Case report: A 53-year-old man underwent neoadjuvant radiochemotherapy for adenocarcinoma of the esophagus with positive lymph nodes. PET/CT showed only a partial response after neoadjuvant therapy. Minimally invasive thoracoscopic esophagectomy in the semi-prone position with selective intuba- tion of the left lung was performed. However, massive bleeding from the thoracic aorta during separation of the tumor resulted in conversion from minimally invasive to conventional right thoracotomy. The bleeding was caused by a five millimeter rupture of the thoracic aorta. The thoracic aortic rupture was treated by suture with a gore prosthesis in collaboration with a vascular surgeon. Esophagestomy was not completed due to hypovolemic shock. Hybrid transhiatal esophagectomy was performed on the seventh day after the primary operation. Definitive histological examination showed T3N3M0 adenocarcinoma. Conclusion: Esophagectomy for cancer of the esophagus is one of the most difficult operations in general surgery in which surgical bleeding from the surrounding structures cannot be excluded. Aortic hemorrhage is hemodynamically significant in all cases and requires urgent surgical treatment.

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