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Multimodality Diagnosis of Mesenteric Ischemia
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Cryptogenic mycotic aneurysm of the superior mesenteric artery

Ali Kordzadeh1, Jiten P Kalyan2, Attila Jonas2

  • 1Department of Vascular and Endovascular Surgery, Mid Essex Hospital Services NHS Trust, Broomfield Hospital, Chelmsford, Essex, UK alikordzadeh@gmail.com.

Journal of Surgical Case Reports
|August 16, 2015
PubMed

Insights

This study reports the first cryptogenic mycotic aneurysm of the superior mesenteric artery (SMA) caused by Enterococcus faecalis (EF). Surgical removal and antibiotics led to full recovery in a 77-year-old male patient.

Area of Science:

  • Vascular Surgery
  • Infectious Diseases
  • Radiology

Background:

  • Visceral artery aneurysms are rare, typically resulting from degenerative arterial disease.
  • Superior mesenteric artery (SMA) aneurysms constitute a small percentage of these rare conditions.
  • Mycotic SMA aneurysms (SMAAs) are exceptionally uncommon, with limited documented cases.

Observation:

  • A 77-year-old male presented with suprapubic/left iliac fossa pain, weight loss, and fever.
  • Computed tomography revealed an incidental 4.4 × 3-cm SMAA without an identifiable primary infection source.
  • Serology and specimen analysis confirmed Enterococcus faecalis (EF) as the causative agent.

Findings:

  • This case represents the first reported instance of a cryptogenic mycotic aneurysm of the SMA caused by Enterococcus faecalis.
  • Successful treatment involved aneurysmectomy without bypass grafting, combined with targeted antimicrobial therapy.
  • The patient achieved a full recovery following the intervention.

Implications:

  • Highlights the importance of considering infectious etiologies in cryptogenic SMAAs.
  • Demonstrates the efficacy of surgical intervention and antimicrobial therapy for mycotic SMAAs.
  • Contributes to the limited literature on rare mycotic aneurysms, specifically those caused by Enterococcus faecalis.

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