Successful Surgical Treatment for Multiple Mycotic Aneurysms of Abdominal Aorta / 日本心臓血管外科学会雑誌

ABSTRACT

A case of multiple mycotic aneurysms of the abdominal aorta is presented. A 62-year-old woman was admitted to our hospital complaining of left abdominal and back pain with persistent high fever. Although the blood cultures were negative during medical treatment, the patient status seemed septic by laboratory findings such as WBC (14, 000/μl), CRP (20.2mg/dl), and ESR (100 mm/h). Abdominal CT and aortography showed two saccular aneurysms in the abdominal aorta, and these aneurysms were considered as mycotic ones because of their rapid growth and clinical features. An urgent operation was performed. The three aneurysmal orifices were identified in infrarenal abdominal aorta and these seemed to be pseudoaneurysms. Although tight inflammatory adhesions were found around the aneurysms, no active infection was detected. After removal of the thrombi and intimal wall with meticulous irrigation, the <i>in situ</i> graft replacement was carried out. All the bacterial cultures of thrombi and intimal wall of aneurysms were negative. The infection had subsided after operation and she remained well without recurrence one year after operation. A few cases of mycotic aneurysm of abdominal aorta have been reported in Japan, but cases with multiple mycotic aneurysms are rare. The mechanism of aneurysmal formation in the present case might be lodgement of circulating organisms within the aortic wall during preceding prolonged antibiotic chemotherapy. The early surgical treatment consisted of <i>en bloc</i> aneurysmectomy, <i>in situ</i> graft replacement, and adjuvant antibiotic chemotherapy might provide good results.