[Case report of infected pseudo-aneurysm after intra-arterial chemotherapy].

A 63-year-old man admitted to emergency center of our hospital with fever and obstructive jaundice. Computed tomography (CT) showed a mass in the head of the pancreas and a dilated bile duct. After performing preoperative biliary drainage, we conducted pancreatico-duodenectomy (PD-II: T3, N1, stage III). As adjuvant chemotherapy, the patient received a hepatic arterial infusion with 5-FU to prevent liver metastasis. A catheter was placed in the right femoral artery and intra-arterial chemotherapy was carried out for one week. After the completion of chemotherapy, swelling and redness of the right inguinal region was observed. CT revealed an infected pseudo-aneurysm of the femoral artery. Despite intravenous antibiotic therapy for 2 days, bleeding and pus discharge at the catheter root were observed. He immediately underwent drainage and primary suture to stop the bleeding. Two weeks after surgery for the infected pseudo-aneurysm, a right external iliac-femoral bypass operation was performed. Five weeks after surgery, he was discharged without further incident. In such cases, it is advisable to drain the infected pseudo-aneurysm following a prompt diagnosis, and perform a secondary bypass operation.

Infective endocarditis complicated with thalamic infarction and mycotic aneurysm rupture: a case report.

A 39-year-old female with mitral valve prolapse experienced left side hemisensory disturbance four months after gastric surgery. Echocardiogram disclosed vegetation on the mitral valve and blood cultures showed growth of enterococcus. With a diagnosis of thalamic infarction complicating infective endocarditis, she was hospitalized for further treatment. After four weeks of antibiotic therapy, she developed sudden headache and obtundation. Imaging studies revealed intracerebral hemorrhage (ICH), resulting from mycotic aneurysm rupture. She survived and recovered after emergency craniotomy and evacuation of the hematoma. However, the ICH recurred six weeks later and the patient died after five days in a deep coma. Patients with mitral valve prolapse are common. Those who have systolic murmur or valvular thickening and redundancy are at particular risk of infective endocarditis and should receive antibiotic prophylaxis perioperatively as recommended by the American Heart Association. Clinical manifestations of infective endocarditis and its complications, as in our patient, are often trivial. Prompt diagnosis and intervention are crucial. In view of the poor prognosis associated with ICH due to mycotic aneurysm rupture, we suggest cerebral angiography be performed in patients presenting with focal neurologic deficits or with warning headache for early detection of accessible lesions for excision.