A hemodialysis patient who developed aortic graft infection, infected aneurysm and aortoesophageal fistula due to vascular access infection: An autopsy report

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  • Yamaguchi Yukiko
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Fukami Kei
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Nasu Makoto
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Sonoda Kazuhiro
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Kaida Yusuke
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Adachi Takeki
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Kasuga Syumon
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Wakasugi Daisuke
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Nagano Makio
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Tanaka Masahiro
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Shibata Ryo
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Kusumoto Takuo
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Yoshimura Jyunko
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Ueda Seiji
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Okuda Seiya
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine

Bibliographic Information

Other Title
  • 自己血管標準内シャント感染から大動脈グラフト感染，感染性大動脈瘤，大動脈食道瘻をきたした血液透析患者の１剖検例
  • 症例報告 自己血管標準内シャント感染から大動脈グラフト感染,感染性大動脈瘤,大動脈食道瘻をきたした血液透析患者の1剖検例
  • ショウレイ ホウコク ジコ ケッカン ヒョウジュン ナイ シャント カンセン カラ ダイドウミャク グラフト カンセン カンセンセイ ダイ ドウミャクリュウ ダイドウミャク ショクドウロウ オ キタシタ ケツエキ トウセキ カンジャ ノ 1 ボウケンレイ

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Abstract

A 73-year-old female with nephrosclerosis underwent hemodialysis treatment 3 times a week over a seven-year period. In 2000, the patient underwent artifical blood vessel replacement of the ascending aorta and stent grafting of the descending aorta because of the asymptomatic dissecting aneurysm. On March 26, 2006, the patient underwent a medical examination due to fever and was admitted to our department due to vascular access infection accompanied by smelly purulent discharge from the vascular access. Therefore, we started antibiotic treatment. Staphylococcus aureus growth was detected on culture of blood and pus from the vascular access. We diagnosed the patient as having aortic graft infection and infected aneurysm based on finding an expansion of the aortic arch on chest X-ray photograph and an aortic aneurysm of the descending aorta was found on chest computed tomography scans on the 3rd day. Thereafter, we continued antibiotic therapy. However, the patient suddenly began to spit blood and developed hemorrhagic shock on the 10th day. Since we detected rupture of the infected aneurysm and aortoesophageal fistula, artifical blood vessel replacement of the ascending aorta, aortic arch and descending aorta, filling in the greater omentum, esophagectomy, esophagostomy and gastrostomy were performed on the 12th day. However, the general state of the patient worsered and the patient died due to septic shock on the 30th day. Dialysis patients have a high risk of infection and may easily become seriously and even fatally ill. When signs of infection are observed in dialysis patients, infected aneurysm should be considered in the differential diagnosis.

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