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Aortic sepsis from an appendiceal abscess
M Mostovych1, L Johnson, R P Cambria
1Department of Surgery, Harvard Medical School, Boston, Massachusetts 02114.
Abstract:
A 75-year-old man with infection in a pre-existing abdominal aortic aneurysm secondary to an appendiceal abscess is described. A single similar case has been reported in the English literature. Appendicitis was diagnosed at exploration. In both cases, the appendix was located in a retroileal position in the retroperitoneum, thereby allowing tracking of the abscess to the aneurysm wall. Resection and extra-anatomic vascular reconstruction were curative.
Insights
A rare case of abdominal aortic aneurysm infection caused by an appendiceal abscess is presented. Surgical intervention, including resection and vascular reconstruction, proved curative for this uncommon presentation.
Area of Science:
- Vascular Surgery
- Gastrointestinal Surgery
- Infectious Disease
Background:
- Appendiceal abscesses are typically intra-abdominal infections.
- Abdominal aortic aneurysms (AAAs) can become infected, forming mycotic aneurysms.
- The contiguous spread of infection from an appendiceal abscess to an AAA is exceptionally rare.
Observation:
- A 75-year-old male presented with an infected abdominal aortic aneurysm.
- The infection was secondary to a retroperitoneal appendiceal abscess.
- The appendix was located in a retroileal position, facilitating abscess tracking to the aneurysm.
Findings:
- This represents only the second reported case in the English literature of an appendiceal abscess causing AAA infection.
- Appendicitis was confirmed during surgical exploration.
- Successful treatment involved surgical resection of the infected aneurysm and extra-anatomic vascular reconstruction.
Implications:
- Highlights the potential for retroperitoneal appendiceal abscesses to directly infect adjacent abdominal aortic aneurysms.
- Emphasizes the importance of considering unusual infectious sources in patients with infected AAAs.
- Demonstrates the efficacy of surgical management in this rare clinical scenario.