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The patient is a 73-year-old male with an infected abdominal aortic graft following an emergency ruptured abdominal aortic aneurysm (AAA) repair. There was no significant background history. He presented to the emergency department for computed tomographic (CT) scan which confirmed 10.2 cm ruptured infrarenal AAA. He soon underwent an emergency open repair (►Fig. 1).On day 3 postoperatively, the patient developed ischemic colitis with sigmoid colon perforation leading to fecal peritonitis and secondary sepsis. An emergency laparotomy, left hemicolectomy, and transverse colostomy were performed and he was shifted to the intensive care unit for the treatment of consequent multiorgan failure.After initial improvement, the clinical progress faltered, prompting a further CT scan. This revealed a large intraabdominal collection. This patient was considered high risk for surgical graft excision because of several factors including the breakdown of his laparotomy wound and the presence of AbstractConservative management of an aortic graft infection is defined as "the nonresectional treatment of an aortic graft that has an established infection." Incidence of aortic graft infections is 0.5 to 5% and the estimated mortality rate from aortic graft infections ranges from 8 to 27%. We present the case of a 73-year-old male patient with an infected abdominal aortic graft following an emergency ruptured abdominal aortic aneurysm repair. Postemergency repair, he developed ischemic colitis with sigmoid colon perforation leading to fecal peritonitis and secondary sepsis. He developed a large infective collection within the aortic sac growing vancomycin-resistant enterococcus sensitive to linezolid. A percutaneous drain was placed in the aortic sac and this was irrigated with linezolid for a total of 28 days. The patient clinically improved. Overall, 7 months later, follow-up scan shows complete resolution of infection and the patient remains clinically stable. Conventional treatment of aortic graft infections involves an extra-anatomical bypass. Percutaneous drainage and antibiotic use may be used as bridging therapy for surgery or as definitive therapy when surgical treatment is impractical. Most aortic graft infections grow gram-positive cocci, the organisms form a biofilm which is protected from the external environment. Percutaneous drainage and antibiotic irrigation could possibly penetrate the biofilm and eradicate infection. Morris et al conducted a study on 10 patients having irrigation therapy and systemic antibiotic treatment and found a 1-year survival rate of 80%. In conclusion, conservative aortic graft treatment may be an effective alternative where surgical intervention is not suitable.

Depression is a common illness that can present in a variety of ways. Therefore, the current literature suggests taking a holistic approach incorporating biological, psychological and social factors, and raising the index of suspicion for alternative explanations in an atypical case as this article illustrates.