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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 1998 Aprile;39(2):171-3

lingua: Inglese

Osteomyelitis of ­the fib­u­la ­due to sep­tic embo­lism: a rare com­pli­ca­tion of a ­graft enter­ic ero­sion. Case ­report

Moreau P. M.

From ­the Centre Medical du Trencavel Beziers, France


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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.

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