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Vascular and Endovascular Surgery
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Aortoduodenal Fistula and Streptococcal Myonecrosis

Ayman S. Abdelrazeq, DM, MSc, FACs

Department of General Surgery, Huddersfield Royal Infirmary, Huddersfield, England, aymonrazeq{at}yahoo.co.uk

Anwar E. Owais, MBBS, MRCS

Department of General Surgery, Huddersfield Royal Infirmary, Huddersfield, England

Firas Mukdad, MBBS, MRCS

Department of General Surgery, Huddersfield Royal Infirmary, Huddersfield, England

Munther I. Aldoori, FRACS, FRCS

Department of General Surgery, Huddersfield Royal Infirmary, Huddersfield, England

Pyomyositis is a rare primary bacterial infection of the skeletal muscles. Pyomyonecrosis is the most severe manifestation of this disease and is associated with a potentially devastating outcome. Patients with peripheral vascular disease presenting with pyomyositis may be difficult to distinguish from those with critical ischemia or synthetic graft sepsis. This article reports on a patient with aortobifemoral bypass graft and severe vitamin B12 deficiency who developed pyomyonecrosis and aortoduodenal fistula. This article highlights the etiologic dilemma, diagnostic difficulties, and management challenges inherent in such cases. Pitfalls in our management of this patient are discussed.

Key Words: Streptococcus • aortoduodenal fistula • myositis • myonecrosis • graft

Vascular and Endovascular Surgery, Vol. 42, No. 3, 268-271 (2008)
DOI: 10.1177/1538574407309678
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