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Primary repair with in-situ interposition graft for infrarenal mycotic aortic pseudoaneurysm
S J Adeeb1, A W Yusha, S A Samad
1Dept. of General Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia.
Abstract:
This is a case report of a pseudoaneurysm due to Salmonella aortitis in a 52 year old man. The condition is rare and represents one of the few cases reported in Malaysia. The diagnosis was made preoperatively by ultrasonography and computed tomography. This was confirmed at surgery where there was a 3 cm defect at the posterior wall of the aorta at L2/3 level. The aneurysmal sac extended to the retrocrural space at the 12th vertebra level cranially on the right side to the lower border of the 3rd lumbar vertebra caudally. It had a smooth fibrous wall and contained a mixture of organised haematoma and pus. At operation the aneurysm was excised, the affected region was carefully debrided and the aorta grafted with an in-situ in-lay graft. Antibiotic therapy was instituted until clinical response was evident, leukocytosis was reduced and blood culture was negative. However 4 months after surgery, the patient returned in irreversible shock and succumbed to disseminated intravascular coagulation secondary to massive upper gastrointestinal haemorrhage from an aortoduodenal fistula.
Insights
This case report details a rare Salmonella aortitis causing a pseudoaneurysm in a 52-year-old man. Despite successful surgical repair, the patient later died from complications of an aortoduodenal fistula.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Abdominal Aortic Aneurysm
Background:
- Salmonella aortitis is a rare but serious condition leading to aortic pseudoaneurysms.
- Early diagnosis and surgical intervention are critical for managing this life-threatening complication.
Observation:
- A 52-year-old male presented with a pseudoaneurysm secondary to Salmonella aortitis.
- Preoperative diagnosis was confirmed via ultrasonography and computed tomography.
- Surgical findings revealed a 3 cm defect in the posterior aortic wall with an aneurysmal sac containing organized hematoma and pus.
Findings:
- The patient underwent successful excision of the pseudoaneurysm, debridement, and in-situ in-lay aortic grafting.
- Postoperative antibiotic therapy was administered until clinical and laboratory parameters improved.
- Four months post-surgery, the patient developed disseminated intravascular coagulation due to an aortoduodenal fistula, leading to death.
Implications:
- This case highlights the challenges in managing Salmonella aortitis and its potential for late complications such as aortoduodenal fistulas.
- Aggressive surgical management combined with appropriate antibiotic therapy is essential.
- Long-term surveillance may be necessary to detect delayed complications after treatment for aortic pseudoaneurysms caused by infection.