In situ aortic thrombosis secondary to intra-abdominal abscess

Area of Science:

• Vascular Surgery
• Infectious Disease
• Radiology

Background:

• Abdominal aortic mural thrombus is rarely observed without underlying aneurysm or atherosclerosis.
• Intra-abdominal infections, particularly perforated appendicitis, can present with unusual complications.

Purpose of the Study:

• To report an exceedingly rare case of in-situ aorto-iliac arterial thrombus formation.
• To investigate the potential link between perforated appendicitis and arterial thrombus development.
• To document the successful conservative management of this rare condition.

Main Methods:

• Case report of a 46-year-old male with perforated appendicitis.
• Initial decline and subsequent consent for appendectomy and abdominal washout.
• Follow-up imaging revealing infra-renal abdominal aortic and left iliac artery mural thrombus.
• Treatment with therapeutic anticoagulation.

Main Results:

• A 46-year-old male developed infra-renal abdominal aortic and left iliac artery mural thrombus after perforated appendicitis.
• The thrombus was not present on initial imaging and appeared during follow-up.
• The patient had no clinical signs of limb ischemia.
• Conservative management with anticoagulation led to complete resolution of the thrombus.

Conclusions:

• Aorto-iliac arterial thrombus formation in the absence of aneurysm, atherosclerosis, or embolic source is exceptionally rare.
• This case suggests a potential association between perforated appendicitis and in-situ aorto-iliac arterial thrombus.
• Conservative anticoagulation is an effective treatment for resolving such thrombi.