抄録
We present the case of a 68 year-old patient who sustained necrotizing fasciitis of a lower extremity two years and six months after an artificial vessel substitution for an aneurysmal rupture of the abdominal aorta. The substitution was done in 1997.
The patient reported local heating and swelling progressively deteriorating on his right thigh along with an attack of fever. Clinical evaluation revealed a wide intramuscular abscess of the right thigh and the systemic inflammatory response syndrome. The initial treatment included irrigation and open drainage with a drug regimen of antibiotics. Immediately after this treatment, he experienced septic shock with marked acidosis and acute renal failure. During a three-month period following this episode of septic shock, the patient experienced two similar episodes Reexamination of computed tomography scans revealed an adhesive fistula between the substituted artificial vessel and the adjacent jejunum. The artificial vessel and jejunum were removed. Artificial reconstruction was performed by left axillo-femoro bypass using a GORETEX Vascular Graft and left external iliac-right external iliac bypass using a saphenous vein graft.
In a patient with an infection of the lower extremity and a past history of substitution of an artificial vessel for the abdominal aorta, the artificial vessel should be considered as a possible origin of the lesion.
