scholarly journals A Rare Case of Aortoenteric Graft Erosion Presenting as Candida glabrata Fungemia

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Muhammad Adeel Samad ◽  
Dhaval Patel ◽  
Martin Asplund ◽  
Diane C. Shih-Della Penna ◽  
Yaseen Tomhe
Keyword(s):  
Computed Tomography ◽  
Gastrointestinal Bleeding ◽  
Candida Glabrata ◽  
Rare Complication ◽  
Bypass Graft ◽  
Graft Infection ◽  
Abdominal Aortic Aneurysm Repair ◽  
Aortic Graft ◽  
Aortobifemoral Bypass ◽  
Computed Tomography Angiogram

Background. An aortoenteric fistula (AEF) describes a communication of the aorta or aortic graft with an adjacent loop of the bowel. Aortic graft erosion is a rare complication of abdominal aortic aneurysm repair. We describe a case of a patient presenting with sepsis from Candida glabrata fungemia secondary to aortoenteric erosion without any symptoms or signs of gastrointestinal bleeding. This is a unique case of Candida glabrata fungemia from aortoenteric graft erosion. Case Summary. This patient is a 75-year-old male with a history of a prior aortobifemoral bypass graft in 2005. He presented with complaints of right paraspinal pain and chills. He had no symptoms of gastrointestinal bleeding or abdominal pain. His white blood cell count was 25,600/mcl (4,000–11,000/mcL) with left shift. The erythrocyte sedimentation rate was 11 mm/hr (0-38 mm/hr), and C-reactive protein was 95.5 mg/L (<=10.0 mg/L). Blood cultures were obtained and eventually grew Candida glabrata. A computed tomography angiogram (CTA) of abdomen and pelvis demonstrated inflammation surrounding the graft concerning for graft infection with additional inflammatory changes tracking down both femoral limbs. He underwent staged bilateral femoralaxillary bypass followed by the excision of aortobifemoral bypass. Conclusion. Patients with aortoenteric erosion can present with sepsis in absence of gastrointestinal bleeding. Emergent computed tomography angiogram (CTA) of abdomen and pelvis should be performed to assess for aortic graft erosion or fistula. Empiric treatment with antibiotics should include antifungal agent like micafungin until the final culture is reported. The definite management is an extra anatomic bypass, followed by graft excision.

Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition

2018 ◽  
Vol 52 (5) ◽  
pp. 386-390
Author(s):  
Jacqueline J. Blank ◽  
Abby E. Rothstein ◽  
Cheong Jun Lee ◽  
Michael J. Malinowski ◽  
Brian D. Lewis ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Bypass Graft ◽  
Graft Infection ◽  
Preoperative Imaging ◽  
Sigmoid Colectomy ◽  
Acute Limb Ischemia ◽  
Bypass Grafting ◽  
Aortic Graft ◽  
Aortobifemoral Bypass ◽  
Aortic Graft Infection

Aortic graft infections are a rare but devastating complication of aortic revascularization. Often infections occur due to contamination at the time of surgery. Iatrogenic misplacement of the limbs of an aortobifemoral graft is exceedingly rare, and principles of evaluation and treatment are not well defined. We report 2 cases of aortobifemoral bypass graft malposition through the colon. Case Report: Case 1 is a 54-year-old male who underwent aortobifemoral bypass grafting for acute limb ischemia. He had previously undergone a partial sigmoid colectomy for diverticulitis. Approximately 6 months after vascular surgery, he presented with an occult graft infection. Preoperative imaging and intraoperative findings were consistent with graft placement through the sigmoid colon. Case 2 is a 60-year-old male who underwent aortobifemoral bypass grafting due to a nonhealing wound after toe amputation. His postoperative course was complicated by pneumonia, bacteremia thought to be secondary to the pneumonia, general malaise, and persistent fevers. Approximately 10 weeks after the vascular surgery, he presented with imaging and intraoperative findings of graft malposition through the cecum. Conclusions: Aortic graft infection is usually caused by surgical contamination and presents as an indolent infection. Case 1 presented as such; Case 2 presented more acutely. Both grafts were iatrogenically misplaced through the colon at the index operation. The patients underwent extra-anatomic bypass and graft explantation and subsequently recovered.

scholarly journals Case Report: Duodenoscopy diagnosis of a secondary aorto-duodenal fistula: A case report and review of literature.

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 594
Author(s):  
Hanen Elloumi ◽  
Melek Ben Mrad ◽  
Imen Ganzoui ◽  
Sonia Ben Hamida ◽  
Wissem Triki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Gastrointestinal Bleeding ◽  
Case Reports ◽  
Clinical Signs ◽  
Prosthetic Graft ◽  
Enteric Fistula ◽  
Prosthetic Reconstruction ◽  
Life Threatening ◽  
Computed Tomography Angiogram

Secondary aorto-enteric fistula (SAEF) is a rare life-threatening complication occurring in patients with previous infrarenal aortic prosthetic reconstruction. The main symptom is a gastrointestinal bleeding. Its diagnosis is challenging due to the lack of a specific clinical signs. The failure of early diagnosis and treatment of this entity can lead to fatal issue. Actually, the abdominal computed tomography angiogram represents the principal exploration to confirm the diagnosis, but it is associated with a moderate specificity and sensibility. Duodenoscopy can highlight the communication between the duodenum and the prosthetic graft, but it is often inconclusive. We report in this manuscript a case of secondary aorto-enteric fistula revealed by occult gastrointestinal bleeding in an elderly patient who is admitted for severe anemia. The SAEF diagnosis was suspected by the computed tomography scan and confirmed by the duodenoscopy showing an exceptional image of Dacron graft protruding in the third duodenum lumen. Unfortunately, the patient died from cataclysmic shock before intervention. We overview also the rare previous published case reports concerning the endoscopic images of secondary aortoenteric fistula and we contrast our findings with those reported in the literature.

scholarly journals Time to Catheter Angiography for Gastrointestinal Bleeding after Prior Positive Investigation Does Not Affect Bleed Identification

2020 ◽  
Vol 10 ◽  
pp. 16
Author(s):  
Akshaar Brahmbhatt ◽  
Pranay Rao ◽  
Andrew Cantos ◽  
Devang Butani
Keyword(s):  
Computed Tomography ◽  
Gastrointestinal Bleeding ◽  
Final Analysis ◽  
International Normalized Ratio ◽  
Catheter Angiography ◽  
Characteristic Analysis ◽  
Coagulation Therapy ◽  
Computed Tomography Angiogram ◽  
Prior Investigation ◽  
Packed Rbcs

Objective: To determine, time to angiography for patients with positive gastrointestinal bleeding (GIB) on prior investigation (endoscopy [ES], nuclear medicine [NM] Tc99m red blood cells (RBC) scan, or computed tomography angiography), affects angiographic bleed identification. Materials and Methods: Visceral Angiograms performed from January 2012 to August 2017 were evaluated. Initial angiograms performed for GIB were included in the study. Exclusion criteria included recent abdominal surgery or procedure (30 days), empiric embolization (embolization without visualized active bleeding), and use of vasodilators, or subsequent angiogram. Timing and results of ES, NM Tc99m RBC scan, or computed tomography angiogram and catheter angiogram were recorded. In addition, age, gender, angiogram time, anti- platelet therapy, anti-coagulation therapy, bleed location, international normalized ratio, and units of packed RBCs received in the 24 h before catheter angiography were included in the study. Results: One hundred and seventy angiograms were included in the final analysis. Forty-three angiograms resulted in the identification of an active bleed (68.9 years, and 67.4% male). All of these patients were embolized successfully. One hundred and twenty-seven angiograms failed to identify an active bleed (70.4 years, and 49.6% male). No significance was found across the two groups with respect to time from prior positive investigation. Receiver operating characteristic analysis demonstrated that units of packed RBCs received in the preceding 24 h were correlated with positive bleed identification on catheter angiography. Conclusion: Time to angiography from prior positive investigation, including ES, NM Tc99m RBC scan, or computed tomography angiogram does not correlate with positive angiographic outcomes. Increasing units of packed RBCs administered in the 24 h before angiogram do correlate with positive angiographic findings.

Iatrogenic Iliofemoral Vein Dissection: A Rare Complication of Femoral Artery Puncture

2018 ◽  
Vol 52 (6) ◽  
pp. 482-485 ◽  
Author(s):  
Trong Binh Le ◽  
Jun Ho Kim ◽  
Keun-Myoung Park ◽  
Yong Sun Jeon ◽  
Kee Chun Hong ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Femoral Artery ◽  
Cerebral Angiography ◽  
Rare Complication ◽  
Iliac Vein ◽  
Stent Insertion ◽  
Venous Outflow ◽  
Iliofemoral Thrombosis ◽  
Computed Tomography Angiogram

Iatrogenic iliac vein dissection secondary to femoral artery puncture is a rare complication that has not yet been documented. A 55-year-old woman presented to our institution with acute right iliofemoral thrombosis 2 weeks after transfemoral cerebral angiography. She was previously healthy and was not taking any medication. Right iliofemoral vein dissection was diagnosed by computed tomography angiography and confirmed by conventional venography. The patient was treated endovascularly with stent insertion, and the venous outflow was patent on the 6-month follow-up computed tomography angiogram.

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