One-Stage Repair of Salmonella enteritidis-Infected Infrarenal Aortic Aneurysm

Abstract

A sixty-three-year-old man was admitted with systemic sepsis, but he was in a hemody namically stable situation and found to have a contained rupture of an infrarenal aortic aneurysm, which was infected with Salmonella enteritidis. An abdominal plain film revealed a gas shadow forming a ring in the midabdomen. Computed tomography (CT) showed a contained rupture of an infrarenal aortic aneurysm with a gas formation in the retroperitoneum. An emergent extra-anatomic bypass from the ascending aorta to (continued on next page) (Abstract continued) the femoral arteries was performed. The retroperitoneal phlegmon and hematoma that contained a large pseudoaneurysm were removed through a separate incision. A CT obtained after surgery showed gas-containing fluid collections in the retroperitoneum and these were followed up by means of CT. Eight months after surgery, the fluid collec tions had resolved. Aggressive surgical treatment and antibiotic therapy have resulted in a successful outcome.

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References

Mendelowitz DS , Ramstedt R. , Yao Jst , et al: Abdominal aortic salmonellosis. Surgery 85:514-519, 1979.

Gomes MN , Choyke PL , Wallace RB : Infected aortic aneurysms. Ann Surg 215:435-442, 1992.

Finseth F. , Abbott WM : One-stage operation therapy for Salmonella mycotic abdominal aortic aneurysm . Ann Surg 179:8-11, 1974.

Jacobs Mjhm , Reul GJ , Gregoric I. , et al: In-situ replacement and extra-anatomic bypass for the treatment of infected abdominal aortic grafts. Eur J Vasc Surg 5:83-86, 1991.

Chan FY , Crawford ES , Coselli JS , et al: In situ prosthetic graft replacement for mycotic aneurysm of aorta. Ann Thorac Surg 47:193-203, 1989.

Atnip RG : Mycotic aneurysms of the suprarenal abdominal aorta: Prolonged survival after in situ aortic and visceral reconstruction. J Vasc Surg 10:635-641, 1989.

Corson JD : Management of infected aortoiliac aneurysm. Arch Surg 126:878-879 (discussion), 1991.

Johansen K. , Devin J. : Mycotic aortic aneurysms. Arch Surg 118:583-588, 1983.

Pasic M. , Carrel T. , Tonz M. , et al: Mycotic aneurysm of the abdominal aorta: Extra anatomic versus in situ reconstruction. Cardiovasc Surg 1:48-52, 1993.

10.

Reddy DJ , Shepard AD , Evans JR , et al: Management of infected aortoiliac aneurysms. Arch Surg 126:873-878, 1991.

11.

Reddy DJ , Lee RE , Oh HK : Suprarenal mycotic aortic aneurysm: Surgical management and follow-up. J Vasc Surg 3:917-920, 1986.

12.

Blaisdell FW , DeMattei GA , Gauder PJ : Extraperitoneal thoracic aorta to femoral bypass graft as replacement for an infected aortic bifurcation prosthesis . Am J Surg 102:583-586, 1961.

13.

Lane GP , Cochrane AD , Fone DR : Salmonellal mycotic abdominal-aortic aneurysm. Med J Aust 149:95-97, 1988.

14.

Parsons R. , Gregory J. , Palmer DL : Salmonella infection of the abdominal aorta. Rev Infect Dis 5:227-231,1983.