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Published on: August 20, 2007
Mycotic Aneurysms in Intestinal Transplantation: A Case Series
Nicola Colucci1,2, Ivan De Gruttola1, Harry V M Spiers1,2,3
1Roy Calne Transplant Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
Introduction:
Mycotic aneurysms (MA) are a potentially fatal complication following intestinal transplantation (ITx). Their occurrence arises from several factors, such as chronic abdominal sepsis, potential for contamination of the vascular grafts during enteric anastomoses and the heightened burden of immunosuppression.
Methods:
A retrospective review of a prospectively maintained database of all adult ITx from December 2007 to June 2025 was conducted.
Results:
Among 168 ITx, six patients (3.6%) experienced eight MA episodes. MA occurred bimodally, early post-transplant (2-8 weeks) or in a later phase (55-377 weeks). Recurrence occurred in two patients, averaging 132.4 weeks after initial diagnosis. A history of hollow viscus perforation or anastomotic leak was present in 83.4%. Diagnosis was peri-operative in two cases due to rupture, while others were detected electively via angio-CT. Recurrences were subtler, identified incidentally or with mild symptoms. Apart from targeted antibiotic and antifungal treatment, management strategy pivoted around endovascular stent grafting (ESG) followed by an aneurysmectomy and creation of a new conduit. Post-operative mortality at first presentation occurred in 66.6% of patients, with 50% within a week. Two patients survived recurrence, with one remaining alive 6.5 years post-diagnosis.
Conclusion:
MA in ITx is rare but commonly fatal, often linked to bowel perforation or anastomotic complications. Diagnosis relies on angio-CT or intraoperative identification at the time of emergency laparotomy. Management involves ESG and conduit resection. Early aggressive control of potential contamination sources after ITx is crucial, though general conclusions are limited by low incidence.
Insights
Mycotic aneurysms after intestinal transplantation are rare but deadly. Early detection and aggressive management, including endovascular stent grafting, are crucial for survival, though outcomes remain poor.
Area of Science:
- Gastroenterology
- Transplantation Surgery
- Vascular Surgery
Background:
- Mycotic aneurysms (MA) are a severe complication following intestinal transplantation (ITx).
- Risk factors include chronic abdominal sepsis, graft contamination, and immunosuppression.
- MA can be a life-threatening post-transplant complication.
Purpose of the Study:
- To investigate the incidence, characteristics, and outcomes of mycotic aneurysms in adult intestinal transplant recipients.
- To evaluate diagnostic methods and management strategies for MA post-ITx.
Main Methods:
- Retrospective review of a prospectively maintained database of adult ITx recipients.
- Analysis of patient data from December 2007 to June 2025.
- Review of MA episodes, including timing, diagnosis, treatment, and outcomes.
Main Results:
- Six out of 168 ITx patients (3.6%) developed eight MA episodes.
- MA occurred bimodally: early (2-8 weeks) and late (55-377 weeks) post-transplant.
- High mortality (66.6%) at initial presentation; endovascular stent grafting (ESG) and conduit resection were primary treatments.
Conclusions:
- Mycotic aneurysms in ITx are rare, frequently fatal, and associated with bowel complications.
- Diagnosis often requires angio-CT or intraoperative findings.
- Aggressive management of contamination sources and timely intervention are critical, but low incidence limits broad conclusions.
