Superior Mesenteric Artery Stenosis Due to Disseminated Tuberculosis in a Pediatric Patient.

Disseminated tuberculosis (TB) associated with mesenteric arteritis has not been established in children. We present the case of an 8-year-old woman who presented with TB and superior mesenteric artery stenosis. Although rare, large vessel involvement from Takayasu arteritis can occur in TB. Evaluation for mesenteric vessel involvement should be considered in pediatric patients presenting with widely disseminated TB and abdominal pain.

Endovascular Therapy for Distal Superior Mesenteric Artery Mycotic Aneurysms due to Infective Endocarditis.

Purpose: To report 3 patients with infective endocarditis who underwent transcatheter arterial embolization for mycotic aneurysm of the distal superior mesenteric artery (SMA). Case Report: Three men (60, 64, and 65 years old) were diagnosed with infective endocarditis. Antibiotics were initiated immediately after admission and continued for several weeks to months. Distal SMA mycotic aneurysm was identified on computed tomography in the vicinity of the ileocolic artery at 33, 26, and 30 days after admission. In case 1, the ileal artery was occluded distal to the aneurysm, with collateral flow to the ileum. In case 2, the mycotic aneurysm was located below the ileocolic artery, which was stenosed distal to the lesion. In case 3, the aneurysm was located on a branch of the ileal artery. Transarterial embolization using microcoils was successfully performed in all patients. No complications associated with embolotherapy or relapse of infection were observed in these 3 patients at 60, 30, and 15 months, respectively. Conclusion: Transcatheter arterial embolization for distal SMA mycotic aneurysm could provide an alternative to open surgery. Anatomical assessment of collateral flow and preprocedure long-term antibiotic therapy could play important roles in preventing bowel ischemia and minimizing the risk of infection relapse.

A surgical case of mycotic aneurysm with Staphylococcus lugdunensis endocarditis.

A 74-year-old man with a history of mitral valve repair was referred to our hospital with fever and diagnosed with mitral valve endocarditis involving occlusion of the superior mesenteric artery. Bacterial cultures showed Staphylococcus lugdunensis. Despite antibiotic therapy, orthopnea ensued due to valve destruction. Emergency mitral valve replacement was performed. Computed tomography on postoperative day 10 revealed a rapidly expanding mycotic aneurysm of the superior mesenteric artery. Aneurysmectomy was undertaken. Mycotic aneurysms of the superior mesenteric artery have not been reported previously in association with Staphylococcus lugdunensis. A rapid diagnosis and prompt surgical intervention are necessary for rescue.

Superior Mesenteric Artery Aneurysm Caused by Aortic Valve Endocarditis: The Case Report and Review of the Literature.

Infectious aneurysms of the superior mesenteric artery are a rare but life-threatening condition due to the risk of visceral ischemia, sepsis, or hemorrhage. In this study, we report the case of a superior mesenteric artery aneurysm (SMAA) secondary to a bioprosthetic valve endocarditis, successfully managed with aneurysm resection and saphenous vein interposition graft. We performed an extensive PubMed-based rewiew of the literature of the last 10 years on SMAA, which include the detection of 38 articles quoting 41 SMAAs. The case histories were divided in 2 groups: 18 cases belonged to nonmycotic group A and 23 cases were included in mycotic group B. In group A, 44.4% of patients were treated surgically, whereas in group B, 90.5%. The 2 study groups significantly differed (P = .01) in terms of surgical treatment. The surgical approach still remains the first choice of treatment in mycotic aneurysm.

Mycotic aneurysm of the superior and inferior mesenteric artery.

OBJECTIVE: Visceral artery aneurysms as a result of arterial degenerative disease are rare (0.1%-2%), and the superior mesenteric artery (SMA) accounts for 3.2% of all reported series. The current incidence of inferior mesenteric artery (IMA) aneurysm is unknown. However, infective causes (mycotic) of SMA and IMA aneurysm as a result of primary, secondary, and cryptogenic etiology remain a separate entity and attain fewer cases in the literature. Currently, there is no consensus on their presentation, diagnosis, and overall management. METHODS: A systematic review and meta-aggregation of literature from 1944 to March 2015 in the English language and of adult subjects in MEDLINE, Ovid, CINAHL, and the Cochrane database was conducted. RESULTS: The median age of patients with SMA aneurysm was 36 (range, 14-92) years, with a significant male predominance (73% vs 27%). In order of prevalence, abdominal pain (n = 25; 65%), low-grade fever (n = 23; 60%), malaise (n = 10; 26%), weight loss (n = 9; 23%), and nausea and vomiting (n = 8; 20%) were the most common presenting signs and symptoms. The most common microorganism was Streptococcus (n = 18; 47%), followed by Staphylococcus (n = 11; 28%). The investigative modality of choice was computed tomography (n = 22; 57.8%), followed by ultrasonography of the abdomen (n = 9; 23%). Primary etiology was noted in 5.4%, secondary in 71%, and cryptogenic in 13% of all cases. Aneurysmectomy alone was associated with bowel resection in four cases (10.5%), whereas aneurysmectomy with interposition vein grafting required no further intervention. The inpatient mortality after surgery was 7.8%, and the overall mortality was 15%. The median follow-up was 12 months (range, 2-120 months). The median age of patients with IMA aneurysm was 48 (range, 22-64) years, with a male predominance of 2:1 and abdominal pain in all cases (n = 3; 100%). The most common microorganism was Streptococcus (n = 2; 66.6%), and the operation of choice was aneurysmectomy (n = 2; 66.6%) after computed tomography scan (n = 3; 100%) as an investigative modality of choice. CONCLUSIONS: The pentad of abdominal pain, pyrexia of unknown origin, malaise, weight loss, and nausea remains the most convincing presentation of mycotic aneurysms of the SMA and IMA. Computed tomography is the investigative modality of choice, and such patients are best served with aneurysmectomy alone in IMA aneurysms and interposition vein grafting in SMA aneurysms after initiation of antimicrobial therapy on suspicion of the diagnosis.

Ruptured and unruptured mycotic superior mesenteric artery aneurysms.

Aneurysms of the superior mesenteric artery (SMA) and branches thereof are uncommon but have a high rate of rupture and mortality relative to other visceral artery aneurysms. Historically, the predominant etiology has been infectious; with a renewed rise in intravenous drug abuse rates in the last decade, we hypothesize a resurgence in septic embolic complications may occur in the coming years. Here, we describe the presentation and management of 2 cases of intravenous drug users presenting with infectious endocarditis and SMA main trunk and branch aneurysms, one of which was ruptured. In addition, we review the literature on these rare clinical entities.

Infective endocarditis associated superior mesenteric artery pseudoaneurysm.

BACKGROUND: Since William Osler first described mycotic aneurysms in the setting of endocarditis in 1885, few pseudoaneurysms (PAs) of the superior mesenteric artery (SMA) have been reported in the literature. We report 2 cases of SMA PA related to infective endocarditis that were managed with open surgery. RESULTS: Here we report 2 cases of SMA PAs treated with different surgical techniques. A 59-year-old male with a history of intravenous drug use presented with abdominal pain and was found to have Streptococcus viridans endocarditis and an SMA PA. A laparotomy was performed, and proximal and distal control of the SMA PA was obtained. After ensuring that Doppler signals were still present in the distal mesentery and the entirety of the bowel was viable, the SMA was ligated proximal and distal to the PA. The patient recovered uneventfully. The second case is a 35-year-old female who presented with abdominal pain and was found to have Streptococcos gordonii endocarditis and an SMA PA for which the patient was initially observed. After several weeks, the patient's condition deteriorated and the patient underwent open ligation of the SMA, proximal and distal to the PA, with a bypass from the infrarenal abdominal aorta to a distal unnamed SMA branch and resection of 3 ft of ischemic small bowel. The patient continued to have recurrent bowel ischemia over the next several weeks and ultimately died. CONCLUSIONS: SMA PAs associated with infective endocarditis are rare, but carry a high risk of rupture and associated morbidity and mortality. Delay in surgical management may increase this risk.

[Infected aneurysm of a branch of the superior mesenteric artery]. / Anévrysme infectieux d'une branche de l'artère mésentérique supérieure.

Aneurysm of the superior mesenteric artery is a rare finding. The risk of rupture is difficult to predict and manage. We report the case of a young woman who developed an aneurysm of the superior mesenteric artery in a context of bacterial endocarditis. Surgical resection without revascularization was successful.

Open repair of superior mesenteric artery mycotic aneurysm in an adolescent girl.

Aneurysmal degeneration of the superior mesenteric artery (SMA) is rare, particularly in the pediatric population. We report the case of a 16-year-old female who presented with abdominal discomfort, back pain, fever, and vomiting. Extensive work-up revealed a 3-cm SMA aneurysm (SMAA) with surrounding inflammation. No bacterial growth was identified on current cultures, but a mycotic etiology was suspected due to recent episodes of suppurative hidradenitis. In addition to broad-spectrum antibiotics, she underwent transabdominal surgical intervention, including proximal and distal aneurysm ligation with aortomesenteric bypass, utilizing the reversed saphenous vein. Although endovascular intervention in the mesenteric arterial system has increased in utilization, patient-specific considerations, such as age and potential for infectious etiology, must drive therapeutic decision-making, with open surgical bypass being liberally employed.

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.

Mycotic superior mesenteric pseudoaneurysm draining into a vein.

A 46-year-old man with a medical history notable only for schizophrenia was admitted to hospital with complaints of general fatigue and high fever. Transthoracic echocardiography on day 6 after admission demonstrated a large vegetation (17 mm) on the anterior leaflet of the mitral valve with mild regurgitation and mild aortic regurgitation. The patient also complained of abdominal pain. Abdominal computed tomography showed a remarkable enlargement of the superior mesenteric artery aneurysm (SMAA). An excision of the SMAA and double valve replacement was performed, and the patient was administered a six-week course of intravenous antibiotic therapy.

Open and endovascular treatment for pseudoaneurysms of the superior mesenteric artery.

BACKGROUND: Pseudoaneurysms of the superior mesenteric artery are rare, and their natural history is characterized by their tendency to rupture, thereby leading to a high mortality rate. Compared with classic surgical techniques (open), in recent years the possibility of endovascular treatment has increased. RESULTS: We report the cases of two patients with a pseudoaneurysm of the superior mesenteric artery. Each case was successfully treated in a different way: open and endovascular surgery. CONCLUSION: Despite the advantages (less risk for the patient) and good results obtained with endovascular surgery, this cannot completely replace open surgery. The choice of the most appropriate therapeutic option for pseudoaneurysms of the superior mesenteric artery depends on the state of the patient and the characteristics of the lesion. Open and endovascular surgical techniques are complementary, not mutually exclusive, techniques.

Mycotic aneurysm of the superior mesenteric artery in a young woman.

Aneurysm of the superior mesenteric artery (SMA) is rare. We, in this study, present the case of a 21-year-old woman with a history of heroin abuse who was admitted to our hospital for infective endocarditis complicated by floating vegetation at the posterior mitral valve. After receiving 2-week antibiotic treatment, the patient had acute abdominal pain. Computed tomography demonstrated an aneurysm at the SMA. The mycotic aneurysm was resected and the mitral valve was repaired successfully. This report reviews the pathophysiology of mycotic aneurysms of the SMA and role of computed tomography in the differential diagnosis of this condition from acute mesenteric ischaemia.

Superior mesenteric artery aneurysm.

A 38-year old woman with mid-epigastric pain, diarrhea, and weight loss, underwent resection of a superior mesenteric artery aneurysm and primary repair of the artery. Pathological examination showed degenerative atherosclerotic changes, marked medial and intimal thickening, and vegetations. Microbiological studies demonstrated Streptococcus viridans as the infecting organism of this mycotic aneurysm. The patient made a good recovery and remained well after 3 years.

[Mycotic aneurysm in acute bacterial mitral valve endocarditis. Apropos of a case]. / Anévrisme mycotique au cours d'une endocardite mitrale bactérienne aiguë. A propos d'un cas.

A 24 year old man presented with acute endocarditis of the mitral valve. Rupture of a mycotic cerebral aneurysm on the 20th day was successfully treated by interventional catheterisation. Several days later, he underwent mitral valvuloplasty under good conditions. The postoperative period was uncomplicated but emergency surgery was required for a mycotic aneurysm of the superior mesenteric artery. The patient was discharged from hospital without severe neurological sequellae and with a continent mitral valve.