Journal Article

A secondary abdominal aorta-duodenal fistula accompanied with acquired Immune Deficiency Syndrome presented with recurrent sepsis: a case report

Yan, Libo, Hu, Xianjin

2024

Overview

Background Abdominal aorta-duodenal fistulas are rare abnormal communications between the abdominal aorta and duodenum. Secondary abdominal aorta-duodenal fistulas often result from endovascular surgery for aneurysms and can present as severe late complications. Case presentation A 50-year-old male patient underwent endovascular reconstruction for an infrarenal abdominal aortic pseudoaneurysm. Prior to the operation, he was diagnosed with Acquired Immune Deficiency Syndrome and Syphilis. Two years later, he was readmitted with lower extremity pain and fever. Blood cultures grew Enterococcus faecium , Salmonella , and Streptococcus anginosus . Sepsis was successfully treated with comprehensive anti-infective therapy. He was readmitted 6 months later, with blood cultures growing Enterococcus faecium and Escherichia coli . Although computed tomography did not show contrast agent leakage, we suspected an abdominal aorta-duodenal fistula. Esophagogastroduodenoscopy confirmed this suspicion. The patient underwent in situ abdominal aortic repair and received long-term antibiotic therapy. He remained symptom-free during a year and a half of follow-up. Conclusions This case suggests that recurrent infections with non-typhoidal Salmonella and gut bacteria may be an initial clue to secondary abdominal aorta-duodenal fistula.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Abdomen / Acquired immune deficiency syndrome / AIDS / AIDS (Disease) / Aneurysms / Anti-Bacterial Agents - therapeutic use / Antibiotics / Aorta / Aorta, Abdominal - microbiology / Aorta, Abdominal - surgery / Bacteria / Blood / Cardiovascular system / Care and treatment / Case Report / Causes of / Complications and side effects / Computed tomography / Contrast agents / Contrast media / Diagnosis / Duodenal Diseases - complications / Duodenal Diseases - microbiology / Duodenal Diseases - surgery / Duodenum / E coli / Efavirenz / Enterococcus faecium / Enterococcus faecium - isolation & purification / Escherichia coli - isolation & purification / Fistula / Fistulae / Health aspects / HIV / Human immunodeficiency virus / Humans / Immunodeficiency / In situ aorta repairment / Infectious Diseases / Internal Medicine / Intestinal Fistula - complications / Intestinal Fistula - microbiology / Intestinal Fistula - surgery / Male / Medical imaging / Medical Microbiology / Medicine / Medicine & Public Health / Microbiota (Symbiotic organisms) / Middle Aged / Parasitology / Pseudoaneurysm / Reconstructive surgery / Recurrence / Risk factors / Salmonella / Salmonella - isolation & purification / Salmonella Infections - complications / Salmonella Infections - diagnosis / Salmonella Infections - drug therapy / Salmonella Infections - microbiology / Secondary abdominal aorta-duodenal fistula / Sepsis / Sepsis - complications / Sepsis - microbiology / Sexually transmitted diseases / STD / Stents / Streptococcus anginosus - isolation & purification / Syphilis / Tropical Medicine