Document Detail


Osteomyelitis of the fibula due to septic embolism: a rare complication of a graft enteric erosion. Case report.
MedLine Citation:
PMID:  9639000     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We report the case of a 70-year-old female who experienced a graft enteric erosion (GEE) three years after a right aorto-femoral bypass. She was treated by right axillo-femoral bypass, removal of the aortic prosthesis and direct aortic suture. The duodenum was stitched up and separated from the aorta by omentoplasty. Bacteriological culture of the removed graft identified Escherichia coli and Peptostreptococcus. Antibiotic therapy consisting of Amoxicillin and Gentamycin was given for seven days. A month later this patient developed a fibula osteomyelitis due to the same germs. She was then treated by surgical excision of the infected tissues and by antibiotics: Amoxicillin, Metronidazole and Gentamycin for one month. This case of embolism into bone due to GEE is a rare complication which indisputably establishes a link between the spontaneously septic cavity of the bowel and bone tissue by way of blood via the interstices of the fabric. The prosthesis may be responsible for blood seeding infection and not only a mere victim. The prosthesis acts as a porous membrane which allows two opposite flows: the passage of blood from graft to bowel and germ migration from naturally septic bowel to blood. When a GEE is encountered, a rigorous management is required to prevent septic embolism. The precise timing of each step of the surgical procedure remains difficult to codify.
Authors:
P M Moreau
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Journal of cardiovascular surgery     Volume:  39     ISSN:  0021-9509     ISO Abbreviation:  J Cardiovasc Surg (Torino)     Publication Date:  1998 Apr 
Date Detail:
Created Date:  1998-07-06     Completed Date:  1998-07-06     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0066127     Medline TA:  J Cardiovasc Surg (Torino)     Country:  ITALY    
Other Details:
Languages:  eng     Pagination:  171-3     Citation Subset:  IM    
Affiliation:
Centre Medical du Trencavel Beziers, France.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anastomosis, Surgical / adverse effects
Anti-Bacterial Agents
Aorta, Abdominal / surgery
Bacteremia / complications*,  drug therapy
Blood Vessel Prosthesis / adverse effects*,  microbiology
Drug Therapy, Combination / therapeutic use
Embolism / complications*
Escherichia coli / isolation & purification
Escherichia coli Infections / complications,  drug therapy
Female
Femoral Artery / surgery
Fibula* / microbiology
Follow-Up Studies
Gram-Positive Bacterial Infections / complications*,  drug therapy
Humans
Iliac Artery / surgery
Intermittent Claudication / surgery
Osteomyelitis / drug therapy,  etiology*
Peptostreptococcus / isolation & purification
Peripheral Vascular Diseases / surgery
Prosthesis-Related Infections / drug therapy,  etiology*
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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