Introduction:

gastrointestinal bleeding is the most frequent clinical debut of aortic graft infections, secondary to an aortoenteric fistula (AEF). We show a case of an atypical debut of prosthetic infection as an incidental finding in image, requested by gluteal abscess and sepsis.

Case report:

a 69-year-old patient, with a medical record of femoropopliteal bypass at 1st portion in both lower extremities and aortobifemoral bypass (2017). When finding the graft infection, he was operated for an extraction of aortobifemoral graft by transverse laparotomy and drainage of right psoas abscess. A fistula was not noticed in preoperative gastroscopy seen at the level of the 3rd distal portion and repaired with a primary suture and jejunal patch. Gluteal abscess samples were taken, showing Candida krusei and Brevibacterium ravenspurgense. Intravenous antibiotic therapy was prescribed in the postoperative period. In the following days, he underwent a supracondylar amputation of the right leg due to worsening of the ischemia in said limb.

Discussion:

AEF is a rare and life-threatening complication of abdominal aortic aneurysm repair. Despite the absence of controlled trials to standardize the management, the best therapy remains the complete graft explantation with replacement by autologous material or extraanatomic reconstruction.

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