Aortoduodenal fistula revealed by acute fever with heavy and swollen red leg

• Published in: Annales de dermatologie et de vénéréologie 2007-11, Vol.134 (11), p.847-850
• Main Authors: Seneschal, J, Orlandini, V, Delage, F, Bérard, X, Beylot-Barry, M, Doutre, M-S
• Format: Article
• Language: fre
• Subjects: Aorta, Abdominal - pathology; Aortic Diseases - diagnosis; Blood Vessel Prosthesis - adverse effects; Candida glabrata - isolation & purification; Candidiasis - diagnosis; Diagnosis, Differential; Duodenal Diseases - diagnosis; Edema - diagnosis; Escherichia coli Infections - diagnosis; Fever - diagnosis; Humans; Iliac Vein - diagnostic imaging; Intestinal Fistula - diagnosis; Leg Dermatoses - diagnosis; Male; Middle Aged; Peripheral Vascular Diseases - diagnostic imaging; Prosthesis-Related Infections - diagnosis; Skin Diseases, Bacterial - diagnosis; Tomography, X-Ray Computed; Vascular Fistula - diagnosis; Venous Insufficiency - diagnosis
• ISSN: 0151-9638
• DOI: 10.1016/S0151-9638(07)92829-X

Aortoduodenal fistulas are rare and severe complications of aortic prostheses. The clinical picture usually includes digestive features and fever, unlike our observation where fistula was revealed by heavy and swollen leg with cutaneous septic abscesses but no digestive signs. A 59 year-old man who had undergone aortoiliac prosthetic repair of an aortic aneurysm 6 years earlier was hospitalized in a dermatology department for fever beginning three months previously associated with a heavy and swollen leg. Clinical and ultrasound examination revealed vascularised cutaneous nodules on the leg. Abdominal CAT showed left iliac venous compression caused by periprosthetic inflammation and particularly retroperitoneal fluid accumulation, gas bubbles in which suggested aortoduodenal fistula, which was confirmed during surgery. Aspirative puncture of abscesses was positive for E. Coli and Candida Glabatra. Aortoduodenal fistula is a rare complication of vascular prostheses. Clinical features include digestive symptoms and fever. However, diagnosis may be difficult and delay surgery. Cutaneous manifestations appear later and are often associated with other symptoms; they are caused by septic emboli or vascular compression. Imaging methods may assist diagnosis, but surgical procedures provide confirmation and form the cornerstone of management.