Khefacha Fahd, Fatma Aouini, Changal Amel, Taieb Raja, Chihaoui Chaima, Jenni Haifa, Saaidi Achraf, Khalifa Mohamed Bechir, Ben Romdhane Nabil
Department of Peripheral Vascular Surgery, Military Hospital Of Tunis, Tunisia.
Department of General Surgery, Military Hospital Of Tunis, Tunisia.
Radiol Case Rep. 2022 Nov 1;18(1):169-172. doi: 10.1016/j.radcr.2022.09.086. eCollection 2023 Jan.
Secondary aortoenteric fistula is an iatrogenic complication after aortic reconstructive surgery presenting with gastrointestinal bleeding and/or infectious symptoms. Infrequently, it may manifest with nonspecific and atypical clinical signs. We present a case of necrotizing fasciitis of the thigh complicating secondary aortoduodenal fistula, diagnosed with CT-scan. A 67-year-old man with a history of an open aortic-bifemoral bypass 6 years ago was admitted for a progressively swollen and painful right thigh for the last month. Through laboratory and morphological (CT-scan) investigations, a secondary aortoduodenal fistula associated with necrotizing fasciitis of the right thigh was discovered. After general supportive care and empiric antibiotherapy, the patient underwent a prosthetic explantation, a resection of the perforated bowel with end-to-end anastomosis, and extensive debridement of the necrotic tissue of the thigh. No revascularization has been attempted. The patient died the next day of multiple organ failure. Secondary aortoenteric fistula is rare but with a poor prognosis. Clinical presentation is not always typical. A high index of suspicion is the most important factor for improving outcomes. There is not a consensus about optimal management. Axillo-bifemoral revascularization and subsequent graft removal seem to be the best therapeutic option.
继发性主动脉肠瘘是主动脉重建手术后的一种医源性并发症，表现为胃肠道出血和/或感染症状。少数情况下，它可能表现为非特异性和非典型的临床体征。我们报告一例继发于主动脉十二指肠瘘的大腿坏死性筋膜炎病例，通过CT扫描确诊。一名67岁男性，6年前曾行开放性主动脉双股动脉搭桥手术，因近一个月来右大腿逐渐肿胀疼痛入院。通过实验室检查和形态学（CT扫描）检查，发现了与右大腿坏死性筋膜炎相关的继发性主动脉十二指肠瘘。在进行一般支持治疗和经验性抗生素治疗后，患者接受了人工血管取出术、穿孔肠段切除端端吻合术以及大腿坏死组织的广泛清创术。未尝试进行血管重建。患者于次日死于多器官功能衰竭。继发性主动脉肠瘘罕见但预后较差。临床表现并不总是典型的。高度怀疑是改善预后的最重要因素。对于最佳治疗方案尚无共识。腋双股动脉血管重建及随后的移植物取出似乎是最佳治疗选择。
