Localized Dissection of an Infected Abdominal Aortic Aneurysm: A Case Report / 日本心臓血管外科学会雑誌

ABSTRACT

Infected abdominal aortic aneurysm is uncommon, but it has a grave prognosis. We report a case of infected abdominal aortic aneurysm with localized dissection that was preoperatively given antibiotics for 1 month, followed by an anatomical vascular reconstruction with a prosthetic graft wrapped with a pedicled omental flap. A 48-year-old man with uncontrolled diabetis mellitus was admitted with fever, appetite loss, and pulsating abdominal pain. Abdominal CT revealed a saccular aneurysmal change in the infrarenal aorta and weakly enhanced surrounding soft tissue density. Two lumens were clearly enhanced in the aneurysm. <i>Klebsiella pneumoniae</i> infection was diagnosed on the basis of blood culture. Pathologically, suppurative inflammation was confirmed in the surrounding tissue and dissection of the media of the saccular aneurysmal wall was indicated. After administration of antibiotics for 1 month, both clinical and laboratory indications of inflammatory reaction improved. The aneurysm was then almost completely resected and replaced with a Y-shaped prosthetic graft covered with a pedicled omental flap. The postoperative course was uneventful. After surgery, antibiotics were administered for 3 more months. The patient is now surviving and has no symptoms 6 months after operaion. Complete removal of the infected lesion and long-term follow-up with antibiotic chemotherapy are important for this situation.