Retroperitoneal Abscess after Endovascular Repair of Infected Abdominal Aortic Aneurysm

ABSTRACT

Infected aneurysm of the aorta is a rare but life-threatening condition. The traditional strategy for treating infected aortic aneurysms is open surgical repair with antibiotic therapy. Endovascular repair of infected aortic aneurysms has been performed only sporadically. Case A 70-year-old man with a history of diabetes who presented with intermittent fever for one month was referred to our institution. Before admission, antibiotic treatment had been already started and on admission, his general condition was not critical. A CT scan showed two saccular aneurysms of the infrarenal abdominal aorta and a retroperitoneal inflammation including hematoma. No microorganism was identified on blood culture. On follow-up CT scan 15 days later, a further increase in aneurysmal diameter was detected and endovascular repair was performed by using Gore Excluder stent graft. The patient was recovered and discharged on hospital day 29. One month after discharge, the patient was readmitted due to chilling and fever. Abdominal CT showed a retroperitoneal abscess around the previously repaired aortic aneurysm. Surgical drainage was performed without reconstruction with extra-anatomical bypass or in situ replacement. Culture from the abscess revealed the growth of Klebsiella pneumoniae. The patient was discharged on postoperative day 31 and continues to be observed.