A woman in her early 70s with a history of infrarenal aortic endarterectomy and aorto-bi-iliac Dacron grafting 4 years before presented with recurrent septicaemias, occasionally polymicrobial and caused by a wide variety of organisms. After treatment for her sixth bacteraemia, enteroscopy showed a small area of ulceration with synthetic graft material protruding into the distal duodenal lumen. This was followed by positron emission tomography/CT, which showed mild increase in tracer uptake in the same region localised by a previously placed haemoclip. Despite urgent vascular surgery to repair the duodenal fistulas and replace the grafts, the patient passed away. Our patient posed a diagnostic challenge due to repeated imaging studies of different modalities and routine endoscopy failing to show a source of sepsis. It is unique due to the variety of organisms cultured as a result of the enteric fistula.
- infection (gastroenterology)
- vascular surgery
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Contributors KG and JS were involved in writing up of the manuscript and obtaining the images. JS and PE were involved in patient follow-up as well as reviewing of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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