A Case of Open Graft Replacement for Abdominal Stent Graft Infection Caused by Cholecystitis
- VernacularTitle:胆嚢炎が原因と考えられた腹部ステントグラフト感染に対し，開腹人工血管置換を施行した1例
- Author:
Hiroe OTANI
1
;
Hiroyuki WATANABE
1
;
Masayoshi OTSU
1
;
Takuto MARUYAMA
1
Author Information
- Keywords: stent graft infection; EVAR; open graft replacement
- From:Japanese Journal of Cardiovascular Surgery 2024;53(3):143-146
- CountryJapan
- Language:Japanese
- Abstract: A 67-year-old man underwent endovascular aneurysmal repair for an abdominal aneurysm at another hospital about a year earlier. He presented to us with complaints of abdominal pain with an accompanying fever. Contrast-enhanced CT revealed a stent graft thrombus, with discontinuity of the aneurysmal wall, and a mass in the left retroperitoneal space, suggesting stent graft infection. The patient's fever initially subsided with antibiotic treatment, but soon recurred. Plain CT revealed an enlarged left retroperitoneal mass, which was determined to be a contained aneurysmal rupture. The stent graft was surgically removed urgently without incident and, upon examination of the removed stent graft, it was noted that there was a section of yellowish-white tissue attached to the stent graft and definitive evidence of infection was apparent. Thorough debridement of the aneurysmal wall was performed, leaving a segment of the posterior wall intact. In-situ reconstruction was carried out using a Gelsoft graft soaked in rifampicin. There was evidence of purulent pus outflow and cholecystitis during the ablation procedure of the hepatic flexure for omental filling. Post cholecystectomy, the reconstructed vascular graft was covered with omentum. A bacterium, Bacteroides thetaiotaomicron, was detected in the pus, bile, and on the stent graft removed during the surgical procedure. Subsequently, a diagnosis of hematogenous stent graft infection during the course of acute cholecystitis was made. The postoperative course of the patient was uneventful, with no recurrence of infection observed in the 3 months following surgical intervention.
