CASE REPORT

Title: Is every infection a cinch?

Authors: Bartosz Bieżyński, Joanna Chorbińska
Supervisor: dr Przemysław Szyber

INTRODUCTION: The abdominal aortic aneurysm is its local widening of more than
50% of the normal width. This disease affects about 4.5% of the population of people
over 40 years of age. One of the methods of treatment of abdominal aortic aneurysms
is an implantation of Y-type (aorto-iliac) vascular prosthesis. In spite of the
development of both biomaterials and surgical technique, infection of the prosthesis,
which often occurs many years after the operation, is still a frequent problem.

CASE REPORT: A 73-year-old patient was admitted to the Department of Vascular and
General Surgery and Transplantation for the diagnosis and treatment of abdominal
aortic aneurysm. Aorto-bi-iliac prosthesis treatment was performed and complicated
by perforation and subsequent sigmoid necrosis. After a three-week stay at ICU and
cure of infection, the patient was discharged home in good condition. Four years later,
the patient was admitted to the clinic ion an emergency basis because of the purulent
fistula in the left groin over the Y-prosthesis anastomosis. Urgent abdominal CT was
performed, in which both arms of the prosthesis were found to be infected and a large
aneurysm of the common right iliac artery back-fed by the external iliac artery. The
patient was qualified for urgent surgery. Fistula excision and drainage of the space
around the arms of the prosthesis were performed (both anastomoses without signs of
leakage). In the intraoperative assessment, the descending character of the infection
was found and its reason was a found apple seed, which was probably the remainder
of sigmoidal necrosis that happened 4 years earlier. External iliac artery was ligated.
After the inclusion of empirical and targeted antibiotic therapy (P. Aeruginosa in the
culture) and obtaining improvement of the local condition, the patient was discharged
from the hospital in good condition. The patient was not qualified for prosthesis
replacement.

CONCLUSIONS: The surgical treatment of gastrointestinal perforation is the method

resulting in best outcome. The laparotomy and rinsing the peritoneal cavity performed
in this state are necessary to achieve a quick improvement of the patient’s health.
However, precision and scrupulousness of such procedure are extremely important, as
is the meticulous revision of the operating field after the surgery.