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Necrotizing fasciitis of the thigh due to a secondary aortoduodenal fistula
Background: 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...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9636004/ https://www.ncbi.nlm.nih.gov/pubmed/36345464 http://dx.doi.org/10.1016/j.radcr.2022.09.086 |
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author | Khefacha, Fahd Fatma, Aouini Changal, Amel Taieb, Raja Chihaoui, Chaima Jenni, Haifa Saaidi, Achraf Khalifa, Mohamed Bechir Ben Romdhane, Nabil |
author_facet | Khefacha, Fahd Fatma, Aouini Changal, Amel Taieb, Raja Chihaoui, Chaima Jenni, Haifa Saaidi, Achraf Khalifa, Mohamed Bechir Ben Romdhane, Nabil |
author_sort | Khefacha, Fahd |
collection | PubMed |
description | Background: 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. Case presentation: 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. Conclusion: 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. |
format | Online Article Text |
id | pubmed-9636004 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-96360042022-11-06 Necrotizing fasciitis of the thigh due to a secondary aortoduodenal fistula Khefacha, Fahd Fatma, Aouini Changal, Amel Taieb, Raja Chihaoui, Chaima Jenni, Haifa Saaidi, Achraf Khalifa, Mohamed Bechir Ben Romdhane, Nabil Radiol Case Rep Case Report Background: 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. Case presentation: 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. Conclusion: 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. Elsevier 2022-11-01 /pmc/articles/PMC9636004/ /pubmed/36345464 http://dx.doi.org/10.1016/j.radcr.2022.09.086 Text en © 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Case Report Khefacha, Fahd Fatma, Aouini Changal, Amel Taieb, Raja Chihaoui, Chaima Jenni, Haifa Saaidi, Achraf Khalifa, Mohamed Bechir Ben Romdhane, Nabil Necrotizing fasciitis of the thigh due to a secondary aortoduodenal fistula |
title | Necrotizing fasciitis of the thigh due to a secondary aortoduodenal fistula |
title_full | Necrotizing fasciitis of the thigh due to a secondary aortoduodenal fistula |
title_fullStr | Necrotizing fasciitis of the thigh due to a secondary aortoduodenal fistula |
title_full_unstemmed | Necrotizing fasciitis of the thigh due to a secondary aortoduodenal fistula |
title_short | Necrotizing fasciitis of the thigh due to a secondary aortoduodenal fistula |
title_sort | necrotizing fasciitis of the thigh due to a secondary aortoduodenal fistula |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9636004/ https://www.ncbi.nlm.nih.gov/pubmed/36345464 http://dx.doi.org/10.1016/j.radcr.2022.09.086 |
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