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Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
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Case report of multiple mesenteric mycotic aneurysms after perforated appendicitis
Anne C M Cuijpers1, Sanne W de Boer2, Christiaan van der Leij2
1Department of Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, the Netherlands.
International Journal of Surgery Case Reports
|January 28, 2021
Summary
Mycotic aneurysms of mesenteric arteries are a rare complication of perforated appendicitis. Endovascular embolization followed by long-term antibiotics successfully treated a ruptured case, highlighting the need for a multidisciplinary approach.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Radiology
Background:
- Mycotic aneurysms are serious infections of arteries, often linked to sepsis.
- Mesenteric artery mycotic aneurysms are exceptionally rare, particularly following perforated appendicitis with purulent peritonitis.
Observation:
- A middle-aged patient developed multiple mesenteric mycotic aneurysms post-appendectomy for perforated appendicitis.
- Clinical deterioration with elevated CRP and falling hemoglobin prompted CT imaging, revealing the aneurysms.
- Aneurysmal rupture necessitated urgent endovascular coil embolization despite risks of bowel ischemia.
Findings:
- Endovascular coil embolization of multiple mesenteric arteries was performed to manage ruptured mycotic aneurysms.
- The patient received prolonged antibacterial and antifungal therapy.
- Complete recovery was achieved without significant complications like bowel ischemia.
Implications:
- This case underscores that mycotic aneurysms of mesenteric arteries are a rare but critical complication of perforated appendicitis.
- Endovascular embolization combined with long-term antibiotics offers a successful treatment strategy for ruptured mycotic aneurysms.
- A multidisciplinary team approach and transfer to a tertiary center are recommended for optimal management.
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