Explantation of infected aortic aneurysm and endograft with ascending aorta to mesenteric bypass for mesenteric ischemia.

A 65-year-old man presented with an infected perivisceral aortic aneurysm after previous treatment of an abdominal aortic aneurysm with an endograft. On presentation, he was septic and had occlusion of the celiac, superior mesenteric, inferior mesenteric, and bilateral renal arteries. He underwent a three-stage procedure: first, axillobifemoral bypass; then resection of the thoracoabdominal aorta; and finally bypass from the ascending aorta to the celiac and superior mesenteric arteries with a rifampin-soaked Gelsoft graft (Vascutek, Renfrewshire, Scotland). The abdominal pain resolved, and the patient remains symptom free 10 months postoperatively. This rare surgical revascularization technique offered a nontraditional solution to a difficult surgical issue.

Septic embolic occlusion of the superior mesenteric artery induced by mitral valve endocarditis.

A 75-year-old woman, who had been treated for rheumatic arthritis, was transferred to our hospital because of acute abdomen and continuous fever for several weeks. She had peritonitis, and abdominal computed tomography detected a thrombus occluding the proximal superior mesenteric artery and infarctions of the kidneys and spleen. Echocardiography showed a large vegetation on the anterior leaflet of the mitral valve. The necrotic small bowel and ascending colon were resected, and mitral valve replacement was performed 5 days later. She suffered from hyperbilirubinemia and pneumonia for several weeks after the operation but recovered successfully thereafter.

[Native valve Aspergillus fumigatus endocarditis with blood culture positive and negative for galactomannan antigen. Case report and literature review]. / Endocarditis por Aspergillus fumigatus en válvula nativa con hemocultivo positivo y galactomanano negativo. Descripción de un caso y revisión de la literatura.

Native valve endocarditis caused by Aspergillus spp. is an uncommon disease with a high mortality rate. Generally, Aspergillus is isolated from affected valve in post-mortem or biopsy specimens. However, its isolation from blood cultures is exceedingly rare. We report a case of fungal endocarditis in a native mitral valve with the isolation of Aspergillus fumigatus both in valve vegetation and in blood culture bottles. The patient underwent valve replacement and antifungal treatment with voriconazole and caspofungin, but he died on post-operative day 45 with disseminated aspergillosis confirmed by necropsy. Paradoxically, galactomannan antigen detection in serum was negative. This is the third case of Aspergillus endocarditis with positive blood culture reported in the literature.

Septic thrombophlebitis of the superior mesenteric vein and multiple liver abscesses in a patient with Crohn's disease at onset.

BACKGROUND: Portal-mesenteric vein thrombosis, pylephlebitis and liver abscesses are rare complications of inflammatory bowel disease (IBD). The purpose of this case report is to relate an unusual presentation of CD in order to show how conservative treatment could be an appropriate option as a bridge to the surgery, in patients with septic thrombophlebitis and multiple liver abscesses with CD. CASE PRESENTATION: We report a case of a 25-year-old man with Crohn's disease (CD) who developed a superior mesenteric venous thrombosis, multiple liver abscesses and pylephlebitis, diagnosed through abdominal ultrasound and an abdominal computed tomography (CT) scan. The patient was successfully treated with conservative treatment consisting of intravenous antibiotics, subcutaneous anticoagulation and percutaneous catheter drainage of liver abscesses. CONCLUSION: We reported an unnusual case of pylephlebitis in CD. Until now this association has not been reported in adult patients at onset. We hypothesise that the infection developed as a result of mucosal disease and predisposed by corticoid therapy. Adequated management was discussed.

Mesenteric adenitis and portal vein thrombosis due to Fusobacterium nucleatum.

We report the first description of portal and mesenteric vein thrombosis associated with suppurative mesenteric adenitis in a 71-year-old woman. The bacterium detected in mesenteric lymph nodes was Fusobacterium nucleatum, an anaerobic Gram-negative bacillus. Our patient had a clinical syndrome of pharyngitis and fever preceding portal vein thrombosis. Abdominal symptoms improved with antibiotics and anticoagulant therapy. This location of F. nucleatum in mesenteric lymph nodes provides an interesting insight into the occurrence of septic thrombosis in the portal vein following pharyngo-tonsillar infection.

Intraoperative US diagnosis of pylephlebitis (portal vein thrombosis) as a complication of appendicitis: a case report.

We report a case of infectious thrombosis of the superior mesenteric vein (pylephlebitis) that was suspected preoperatively with computed tomography and confirmed at intraoperative ultrasonography as confined to the extrahepatic portal vein and superior mesenteric vein. Intraoperative ultrasonography revealed intraluminal echogenic thrombus material in the dilated superior mesenteric and extrahepatic portal veins, slightly dilated open splenic vein, and numerous venous collaterals in the hepatoduodenal ligament. When preoperative imaging studies are inconclusive, intraoperative sonography can confirm the correct diagnosis of pylephlebitis and may give valuable information about the extent of the thrombosis.

The role of gastrointestinal microflora in the pathogenesis of complications of mesenteric ischemia.

Mesenteric ischemia is a catastrophic event, which has a mortality due to florid sepsis that approaches 100%. The demography of the bacterial changes has not been documented. After 72 hr of colonic ischemia in the dog, the total number of anaerobic organisms increased while the number of aerobic organisms decreased. After 24 hr of ischemia, anaerobic bacteria appeared only in the portal vein and persisted. Cultures of peritoneal fluid and aortic blood became positive for the same anaerobic organisms after 48 hr. Acute colonic ischemia promotes a relative overgrowth of intraluminal anaerobic bacteria, which progressively invade the portal vein and later the systemic circulation.

Early portal anaerobic bacteremia in mesenteric ischemia.

The progressive changes in colonic flora and the pattern of bacterial invasion of extracolonic sites were studied in a canine ischemic colon preparation. After 72 hours of colonic ischemia produced by ligation of the common colic and caudal mesenteric arteries, the total number of anaerobic organisms increased, with a concomitant decrease in aerobic organisms within the colon lumen. After 24 hours of ischemia, anaerobic bacteria only appeared in the portal vein and persisted. Aortic blood and peritoneal fluid cultures became positive after 48 hours with the same organisms. Polymicrobial intra-abdominal abscess and systemic Escherichia coli bacteremia occurred only in one animal with necrotic colonic disruption. Acute colonic ischemia promotes an overgrowth of intraluminal anaerobic bacteria, which penetrate the mucosal barrier and progressively invade the portal vein and, later, the systemic circulation.