Abstract

To the Editor:

A 78-year-old female with an aortobifemoral bypass graft two years previously was seen in consultation for a 3-month history of recurrent episodes of sepsis with Enterobacter cloacae. Each episode was treated with antibiotics; however, following a brief regression, the symptoms recurred each time. Extensive workup, including computed tomography (CT) of the chest, abdomen, and pelvis, and indium scans were unremarkable. Laboratory tests at the current admission revealed a white blood count of 33.1 K/mm³ (3.8–10.8 K/mm³); hemoglobin of 9.7 gm/dL (13.8–17.2 g/dL), and a hematocrit of 28.6% (44–51%). A repeat CT scan of the abdomen showed a patent aortobifemoral bypass graft with limited retroperitoneal emphysema in the periaortic region. Upper endoscopy revealed the prosthetic graft with erosion of the distal duodenum. Surgery was offered but the patient refused. She was then continued on antibiotics and died in hospice care one month later.