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Abdominal aortic aneurysm infected with Campylobacter fetus subspecies fetus
E J Rutherford1, J W Eakins, J G Maxwell
1Department of Surgery, New Hanover Memorial Hospital, Wilmington, NC 28402.
Abstract:
We report a survivor of Campylobacter fetus septicemia from an infected abdominal aortic aneurysm who was successfully treated with an anatomic graft reconstruction and antibiotics. According to a survey of the English-language medical literature this was the fourth such patient successfully treated. C. fetus sepsis associated with an abdominal aortic aneurysm was first reported in 1971. The first patient to survive reconstruction of an aortic tube graft aneurysm infected with C. fetus was reported in 1983. Because the natural history of an aneurysm infected by C. fetus appears to be rapid progression to rupture, patients should be operated on promptly. All patients reported in the literature who were operated on before rupture survived. Survival was independent of the type of reconstruction. When the aneurysm ruptured all patients died. Whereas extraanatomic bypass is generally considered the procedure of choice for an infected abdominal aneurysm, the aneurysms of our patient and three other patients cited in the literature were reconstructed with anatomically placed prosthetic grafts. In the absence of other contraindications such as a grossly evident purulent infection, an abdominal aortic aneurysm infected by C. fetus may represent a subset of infected aneurysms that can be treated successfully with an anatomically placed prosthetic graft and antibiotics.
Insights
Campylobacter fetus septicemia in abdominal aortic aneurysms can be successfully treated with anatomic graft reconstruction and antibiotics. Prompt surgical intervention before rupture is crucial for survival in these rare, aggressive infections.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Medical Microbiology
Background:
- Infected abdominal aortic aneurysms (IAAA) are rare but life-threatening conditions.
- Campylobacter fetus (C. fetus) septicemia is an uncommon cause of IAAs, often associated with rapid progression and high mortality.
- Historically, extraanatomic bypass has been the preferred surgical approach for IAAs.
Observation:
- This report details a survivor of C. fetus septicemia from an infected abdominal aortic aneurysm.
- The patient was successfully treated with anatomic graft reconstruction and antibiotics.
- Literature review identified this as the fourth successfully treated patient, with C. fetus IAAs first reported in 1971.
Findings:
- Prompt surgical intervention before aneurysm rupture is critical for patient survival.
- All reported patients operated on before rupture survived, irrespective of reconstruction type.
- Survival was achieved with anatomically placed prosthetic grafts in this and three other reported cases, challenging the traditional preference for extraanatomic bypass.
Implications:
- An abdominal aortic aneurysm infected by C. fetus may represent a distinct subset of IAAs amenable to treatment with anatomic prosthetic graft reconstruction and antibiotics.
- This approach may be viable in the absence of gross purulent infection.
- Early diagnosis and prompt surgical management are paramount for improving outcomes in C. fetus infected aortic aneurysms.