Surgical experience with Salmonella-infected aneurysms of the abdominal aorta

Five patients, aged between 64 and 75 years with Salmonella-infected abdominal aortic aneurysms were surgically treated between 1993 and 1995 at the National Cheng Kung University Hospital. Cultures of aneurysmal wall tissue and blood yielded Salmonella enteritidis Group B in three patients and Salmonella choleraesuis in the remaining two. All patients presented with fever and abdominal or back pain. Pulsatile masses were noted in only two patients. Infrarenal abdominal infected aneurysms were demonstrated by computed tomography and aortography in each patient. The five patients underwent aneurysmal resection with in situ graft reconstruction from 1 to 20 days after the diagnosis was made. The graft was wrapped with an omental pedicle. Duodenal repair was performed in one patient due to an aortoduodenal fistula found during surgery. He died 19 days after surgery because of duodenal leakage and uncontrolled sepsis. Four patients survived and remained well 11 to 34 months (mean, 25 mo) after surgery. Postoperatively, only one patient developed adhesion ileus and required enterolysis. Parenteral antimicrobial therapy was continued in all patients after surgery for 2 to 4 weeks; only one patient had an additional 4 months of oral antibiotics. Although the number of patients was small, the survival rate was high, at 80%. Our experience suggests that Salmonella-infected aneurysms of the abdominal aorta can be successfully treated by resection of the aneurysm with extensive debridement followed by in situ graft interposition with omentum wrapping. Once diagnosed, the patients should be scheduled for surgery as soon as possible. Antibiotics should be continued parenterally for at least 2 to 4 weeks postoperatively. While long-term suppressive antibiotic therapy is usually recommended, it might not be essential with our surgical approach.