The presence of bilirubin in the perigraft fluid collections as an indicator of graft-enteric fistula

Abstract

Background. Graft-enteric fistulas are among the most dangerous complications in vascular surgery. The successful treatment of this complication depends on early and unequivocal diagnosis. The presence of perigraft fluid is one of the signs of vascular graft infection. Its specificity, however, is low. The purpose of this study was to determine the value of biochemical and microbiological analysis of low-density perigraft fluid in early diagnosis of prosthetic graft infection and graft-enteric fistula.
Material and methods. Twenty-four fluid samples from perigraft fluid collections were analyzed. The samples were obtained from 17 patients with suspected vascular prosthetic graft infection, including 5 patients with intraoperatively diagnosed graft-enteric fistulas and from 7 patients who underwent Dacron mesh repair of abdominal hernias.
Results. High concentrations of total and direct bilirubin, low concentrations of urea and an absence of inflammatory infiltration surrounding the fluid collection in the patients with graft-enteric fistulas were found. The total to direct bilirubin ratio was low, which indicated the dominance of direct bilirubin. In patients without graft-enteric fistulas and in patients after abdominal hernia mesh repair the concentration of total and direct bilirubin was lower, the concentration of urea was higher and inflammatory infiltration around fluid collection was observed. The differences, however, did not reach statistical significance.
Conclusions. High concentrations of total and direct bilirubin in perigraft fluid are not an unequivocal sign of the coexistence of graft-enteric fistulas. The low concentration of urea could be more useful in differential diagnosis of perigraft fluid collections.