Tuberculous pancreatitis complicated by ruptured splenic artery pseudoaneurysm.

Tuberculosis involving the pancreas is rare. We report a patient with pancreatic tuberculosis complicated by haemorrhage from a splenic artery pseudoaneurysm. As far as we are aware, the development of a splenic artery pseudoaneurysm in association with a large caseating mass of tuberculous pancreatic lymph nodes has not been reported previously. We review the literature and discuss the varied presentations of tuberculosis involving the pancreas or the pancreatic bed and its draining lymph nodes.

Mycotic splenic artery aneurysm secondary to Coxiella burnetii endocarditis.

Mycotic artery aneurysms are rare but potentially lethal vascular lesions due to their high risk of rupture. Bacterial endocarditis as well as trauma and inadequate immunity are predisposing factors. Surgery remains the treatment of choice, although alternative methods have been used. We report the first known case of a 6 cm mycotic splenic artery aneurysm proximal to the splenic hilum, secondary to bacterial endocarditis from Coxiella burnetii. Resection of the aneurysm, splenectomy, and distal pancreatectomy were performed. In all patients with culture-negative endocarditis and mycotic aneurysm, C. burnetii infection should be ruled out.

Arterial infections in the new millenium: an old problem revisited.

The natural history of infected aneurysms or arterial infections is characterized by rapid expansion leading to rupture, pseudoaneurysm formation, and sepsis. Treatment options include in situ grafting either with prosthetic or autogenous grafts or with cryopreserved allografts (CPAs), resection of the aneurysm with remote bypass grafting, and ligation. The purpose of this study was to review our recent experience with these infections and to present long-term follow-up with in situ CPAs. From January 2000 through June 2005, we treated nine patients with infected aneurysms and one patient with an infection without aneurysm formation. The infection involved the infrarenal abdominal aorta in six patients and the femoral artery in three patients. One patient had an infected splenic artery aneurysm. Aortic rupture occurred in five of the six patients with infected aortas. Two of the three patients with infected femoral aneurysms presented with recurrent hemorrhage. Of the six patients with aortic infections, five were treated with in situ CPAs. One patient was treated with aortic resection and axillofemoral grafting. Two patients with femoral aneurysms were treated with in situ CPAs, and the third patient underwent aneurysm resection and prosthetic grafting through the obturator foramen. The patient with the splenic aneurysm underwent combined valve replacement, aneurysm resection, and splenectomy. Three of the six patients with aortic infections died postoperatively, all of whom were septic at presentation. The cause of death in these three patients was multiple organ failure in two and overwhelming sepsis in one. The three survivors are alive and well with up to 5-year follow-up. The three patients with infected femoral aneurysms are alive and well with follow-up extending to 44 months. The patient with the splenic aneurysm is doing well. No recurrent infections have been noted among the survivors. The CPAs have remained structurally intact in all. The mortality rate among patients with abdominal aortic infections remains high and is likely related to their preoperative septic state. In situ grafting with CPAs appears to be a reasonable treatment option for arterial infections. CPAs appear to maintain their structural integrity and to be resistant to recurrent infection.

[Mycotic aneurysm of the splenic artery. A rare complication of surgically treated infectious endocarditis and its causative cardiac lesion]. / Anévrisme mycotique de l'artère splénique. Une localisation rare des endocardites infectieuses traitée chirurgicalement en même temps que la cardiopathie causale.

The authors report the case of a 59 year old woman with mitral valve streptococcal endocarditis complicating rheumatic valvular disease with several metastatic septic complications. In addition to ocular and cerebral localisations, the patient developed a very rare mycotic aneurysm of the splenic artery. Mitral valve replacement was necessary because of severe mitral regurgitation with major dilatation of the left heart chambers. This surgery was performed under high dose heparin therapy. Large aneurysms of the splenic artery carry a high risk of rupture. This splenic artery aneurysm was treated in the same operative session as the valvular disease by a sternolaparotomy: the aneurysm was operated first of all, and then valvular replacement was performed. Three years later, the patient is well and cured of the endocarditis. To the authors' knowledge, this is the third report of mycotic aneurysm of the splenic artery and the first case combined with surgery of the infectious valvular disease and the gastro-intestinal artery aneurysm.