Abstract
Here we report a case in which a graft-enteric erosion between a bifurcated graft and the ileum caused a recurrent,septic embolism. A 71-year-old man, who had undergone an aorto-bifemoral bypass due to arteriosclerotic occlusionof the bilateral iliac arteries, has been suffering from high fever and blue toes in his left leg, followed by remission ofthe symptoms by administration of antibiotics. We was admitted because of the recurrence of the symptoms. Computedtomography revealed an occlusion of the left limb of the bifurcated graft and a small amount of perigraft fluidcollection. A presumptive diagnosis of graft infection in the left limb of the bifurcated graft was made and excision ofthe infected graft and revascularization were carried out. We found that the ileum was strongly adherent to the graftbody, with formation of the graft-enteric erosion. Resection of the involved ileum, total excision of the bifurcated graft,and extra-anatomical vascular reconstruction were performed. Mural thrombi inside the infected graft contained aseptic mass and were thought to be the source of the recurrent septic emboli. This postoperative course was uneventful.The patient received oral administration of amoxicillin for 6 months. So far there is no sign of infection, 18 month afterthe operation.
