PMC9636004_01
CT-scan with intravenous injection of contrast medium showing the migration of the aortic prosthesis (asterisk) into the duodenum with breach into the posterior duodenal wall (arrow).
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Given the presence of the aortic prosthesis, a secondary fistula was suspected and the patient underwent a CT-scan with intravenous contrast which demonstrated an aortic prosthesis migrated into the 4th duodenum associated with an infiltration of the retroperitoneal fat (Fig. 1).
CT-scan with intravenous injection of contrast medium showing the fluid and gas (yellow arrow) surrounding the aortic prosthesis.
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It was surrounded by fluid and gas (Fig. 2), with downward extension into the thigh around the femoral artery and involvement of the adjacent muscles (Fig. 3).
CT-scan with intravenous injection of contrast medium showing the fluid and gas collection within the deep layers of the thigh.
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Moreover, the CT-scan showed a 240 x 110 mm fluid and gaseous collection between the anteromedial and posterior compartments of the right thigh (Fig. 4).
Biliary contaminated aortic prosthesis (arrow) perforating the Treitz angle. The asterisk showed the duodenal mucosa.
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Treitz with large ulceration on its posterior wall (Fig. 5, Fig. 6). There was no direct communication between the aorta lumen and the bowel lumen.
Intraoperative aspect of the pus into the thigh.
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A prosthetic explantation, a resection of perforated bowel with end-to-end anastomosis between the 3rd duodenum and the first jejunal loop, and an extensive debridement of the necrotic tissue of the thigh were performed (Fig. 7).