RESUMEN
An aortodigestive fistula can be revealed by a peripheral septic wound when patient have aortic endovascular prosthesis. Our clinical case is about a 69-year-old patient with an abscess of the lateral aspect of his left lower limb. He has been treated few years ago for an aorto-abdominal anevrysm by an aortobifemoral prosthesis. In spite of a negative initial assessment for an aortodigestive fistula, anaerobic germs were found into the abscess. The initial treatment associated debridement, negative pressure therapy, dermal substitute and a split thickness skin graft for the loss of cutaneous substance. Months later, in front of an unexplained skin healing delay and fever, we realised new assessment bringing to light an aortodigestive fistula. Furthermore, the local bacterial samples from the wound and the hemocultures found both a lot of Escherichia Coli. The change of the aorto-bifemoral prosthesis and the cure of the aortodigestive fistula allowed the complete healing of the loss of cutaneous substance of the leg. The aortodigestive fistulas have a very high mortality. Because of their difficult diagnosis, their clinical suspicion has to start a complete medical assessment. Every septic wound when patients have vascular prosthesis is suggestive of an aortodigestive fistula.
Asunto(s)
Enfermedades de la Aorta/terapia , Infecciones por Escherichia coli/terapia , Fístula Intestinal/terapia , Enfermedades Cutáneas Bacterianas/terapia , Fístula Vascular/terapia , Anciano , Antibacterianos/uso terapéutico , Aneurisma de la Aorta Abdominal/cirugía , Enfermedades de la Aorta/diagnóstico , Infecciones por Escherichia coli/diagnóstico , Humanos , Fístula Intestinal/diagnóstico , Pierna/microbiología , Masculino , Terapia de Presión Negativa para Heridas , Enfermedades Cutáneas Bacterianas/diagnóstico , Piel Artificial , Fístula Vascular/diagnósticoRESUMEN
Recurrence, metastasis and mortality due to squamous cell carcinoma are all most often linked to late or inappropriate management and/or aggressive histological types. In consequence, clear guidelines for management are necessary. The aim of this article is to detail clinical management of squamous cell carcinomas based on the official guidelines.