| Mycotic Inferior Mesenteric Aneurysm
Penetrating to Duodenum: Observation of the Formative Course |
(First Department of Surgery, Hirosaki University
School of Medicine, Hirosaki, Japan)
| Chikashi Aoki |
Ikkoh Ichinoseki |
Mamoru Munakata |
| Yasuyuki Suzuki |
Kouzou Fukui |
Shunichi Takaya |
| Ikuo Fukuda |
|
|
|
A 64-year-old woman who had a fever
and low back pain was referred to our institution. Abdominal
computed tomography revealed a low density area around the aorta
and inferior mesenteric artery and liver abscess. Under the diagnosis
of mycotic abdominal aneurysm, intravenous administration of
antibiotics was started and her symptoms improved. On the 12th
day after admission, the patient developed hematemesis and an
emergency CT scan revealed enlargement of the low density area
around the aorta and dilatation of the inferior mesenteric artery
diameter to 16mm. Urgent operation was performed under the diagnosis
of impending rupture of the mycotic aneurysm. Necrotic tissue
and hematoma was recognized outside the aorta, and this mass
firmly adhered to the duodenum. Communication between the abdominal
aorta and the duodenum through the inferior mesenteric artery
was confirmed. The infected aneurysmal area of the aorta was
almost completely resected by closing the infra-renal aorta and
terminal aorta above the bifurcation and a left axillo-femoral
bypass was established. The culture of the necrotic tissue revealed
Klebsiella pneumoniae. Antimicrobial therapy was continued
and the patient was discharged from the hospital on postoperative
day 46. Because the mortality rate of mycotic aneurysm penetrating
to the duodenum is high, early diagnosis and treatment is important.
We present a successfully treated case of mycotic aneurysm in
which the formative course was observed from an early stage of
infection. We observed the process of mycotic aneurysm formation
and aorto-duodenal fistula generation despite antibiotic therapy.
Close observation of periaortic inflammation and early surgical
intervention is necessary in such patients.
Jpn. J. Cardiovasc. Surg. 33: 287-290 (2004) |
|
