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Case Reports in Surgery
Volume 2013, Article ID 421780, 4 pages
http://dx.doi.org/10.1155/2013/421780
Case Report

Purulent Cutaneous Fistula: As the First Symptom of the Late Aortic Stent-Graft Infection—A Case Report and Review of the Literature

1Department of General and Vascular Surgery, Medical University of Silesia, 40-635 Katowice, Poland
2Department and Unit of Pathophysiology, Medical University of Silesia, 40-635 Katowice, Poland

Received 9 May 2013; Accepted 30 June 2013

Academic Editors: E. Ishikawa, S. Landen, and G. Sandblom

Copyright © 2013 Damian Ziaja et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose. Aortic stent-graft infection with fistula formation is a rare complication with high mortality rate when treated surgically by stent-graft removal. We report a case of a patient with aortic stent-graft infection, prosthetic-duodenal, and prosthetic-cutaneous fistulas operated without the removal of an infected prosthesis and ineffectively tailored antibiotic therapy. Case Report. A 66-year-old patient with high cardiovascular risk and endovascular stent-graft implantation developed a symptomatic infection of the aortic stent graft 42 months after procedure. It was manifested by iliolumbar muscle abscess and two fistulas: prosthetic cutaneous and prosthetic duodenal. The prosthetic-duodenal fistula was excised and separated from the prosthesis. The perforation within the duodenum was closed in layers. Iliolumbar abscess was removed and drainage was effected .The stent graft was left. The patient received tailored antibiotic therapy. He was readmitted to hospital after 4 weeks with symptoms of infection and leakage of pus discharge in the lumbar area. Despite the antibiotic therapy, the total parenteral nutrition of the patient’s clinical status and malnutrition deteriorated and he died of cardiac arrest. Conclusion. The presented case confirms that leaving off of the infected stent graft in the patient with severe comorbidity and treated with a tailored antibiotic therapy may not be effective.