Endograft infection following emergency repair for abdominal aortic aneurysm dissection and the undervalued role of the bowel reservoir

Endograft infection after emergency endovascular aortic repair (EVAR) procedure has received less attention than other complications which usually occurs soon after endograft positioning. Consequently, clear guidelines for prevention and treatment of endograft infection have yet to come. We report a case of a 85 years old patient treated with an emergency EVAR procedure for a fissured abdominal aortic aneurysm, whose immediate follow up was complicated by a prolonged upper gastrointestinal occlusion. Six months later he developed an endograft infection due to intestinal flora. After exclusion of all other possible causes, bacteria translocation from the bowel appears the only plausible mechanism. This case highlights the importance of the gastrointestinal tract as a potential source of endograft infection and suggests how a clinical condition representing potential reservoir of infection should be managed properly.