Abstract
A 66-year-old male with the symptoms of fever and abdominal pain was referred to our hospital. The patient had undergone aortic replacement with a Y-shaped vascular prosthesis for abdominal aortic aneurysm 18 months previously. Blood culture revealed the presence of Enterobacter aerogenes and a diagnosis of prosthetic vascular infection was made.
On laparotomy the right leg of the vascular prosthesis was found to adhere to the jejunum and, moreover, emerge in the jejunal lumen, indicating so-called Graft-Enteric Erosion (GEE). The operative treatment consisted of removal of the infected graft, closure of the intestinal wound and insertion of a vascular prosthesis from the right axillary to the bilateral femoral arteries to bypass the infected aortic segment. The postoperative course was uneventful, with fever and abdominal pain disappearing soon after the operation. Now, 2 months after the operation, he is progressing favorably.
GEE following prosthetic replacement of vessels, though of rare occurrence, is important as one of the graft infections that carries a high mortality rate. Bunt et al. reported that the mortality rate of GEE was 20% with appropriate surgical measures, while it was 100% with conservative therapy alone. In the treatment of GEE, early diagnosis, removal of the infected graft and non-anatomical reconstruction of circulation are of major prognostic importance.
