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Patrick K, Helwig W, Felix B, Antonia F, Theresa K, Manfred K, Alexander K, Gernot B, Daniela K, Magdalena F, Reinhold H, Matthias B, Reinhold F. Systematic literature review and meta-analysis of Clostridium septicum aortitis. J Vasc Surg 2022; 76:595-604.e1. [DOI: 10.1016/j.jvs.2022.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
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Lehman B, Miller RM, Richter SS, Keller G, Tan C, Rodriguez ER, Roselli EE, Rehm SJ. Clostridium septicum-infected aortic aneurysm or graft is a deadly diagnosis. J Vasc Surg 2019; 71:1781-1788. [PMID: 31843297 DOI: 10.1016/j.jvs.2019.09.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Clostridium septicum is an anaerobic, motile, spore-forming, toxin-producing gram-positive bacillus that can lead to rapidly progressive gas gangrene due to the release of alpha toxin. Aortic aneurysm secondary to C. septicum infection is a rare condition with 60 cases reported in the literature; however, we have recently treated several patients with the condition in our large tertiary care and aortic center. METHODS Blood and tissue culture results collected between January 2005 and January 2018 and maintained in the microbiology laboratory database at the Cleveland Clinic were reviewed to identify those with C. septicum reported. Each was reviewed to determine radiographic or histopathologic correlation with aortic disease. RESULTS Seven cases of C. septicum aortitis were reviewed. Underlying malignant disease was found in four cases and a history of remote malignant disease in one case. The most common location for infection was the infrarenal abdominal aorta. Vascular surgery had previously been performed in three of the cases. Five of the seven patients underwent operative repair. All patients were treated with β-lactam antibiotics. The two patients who did not undergo an operation died, which is consistent with the 100% mortality described in the literature. Of the five patients who underwent an operation, there was only one documented survivor and one was lost to follow-up. CONCLUSIONS In the largest reported case series, only a small percentage of patients with C. septicum-infected aortic aneurysms survived >1 year. In the patients described, those who did not receive an operation had 100% mortality. Earlier recognition and prompt operation with appropriate antimicrobial therapy are needed to improve the outcome of patients diagnosed with this rare infection.
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Affiliation(s)
- Bethany Lehman
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Ryan M Miller
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Sandra S Richter
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - George Keller
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Carmela Tan
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Susan J Rehm
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio.
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Turnbull G, Spierits E, Russell D, Clarke J, Picard F, Sarungi M. Clostridium septicum arthroplasty infection: beware of occult aortitis and malignancy. Scott Med J 2018; 63:132-139. [DOI: 10.1177/0036933018793525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The Clostridia species are responsible for life-threatening conditions such as tetanus, botulism and gas gangrene. Clostridium septicum is a rare cause of clinical infection, accounting for less than 1% of blood culture samples that test positive for Clostridia. However, C. septicum bacteraemia is associated with greater than 60% mortality and in over 80% of cases is associated with an underlying malignancy. Case presentation We present a review of the literature and the first case of an acute arthroplasty infection and concurrent infective aortitis caused by this organism in the absence of an identified underlying malignancy. Early diagnosis and multi-disciplinary input resulted in the patient surviving a rare and potentially fatal infective aortitis and septic arthritis. Conclusion This case demonstrates the importance of early systemic investigation to exclude occult infective aortitis in C. septicum infection. The key role of multi-disciplinary input into the management of this often fatal infection is also discussed along with the requirement to exclude occult gastrointestinal and haematological malignancy.
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Affiliation(s)
- Gareth Turnbull
- Clinical Research Fellow, Department of Orthopaedic Surgery, Golden Jubilee National Hospital, UK
| | - Euan Spierits
- Clinical Research Fellow, Department of Orthopaedic Surgery, Golden Jubilee National Hospital, UK
| | - David Russell
- Consultant Trauma and Orthopaedic Surgeon, Department of Trauma and Orthopaedic Surgery, University Hospital Ayr, UK
| | - Jon Clarke
- Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, Golden Jubilee National Hospital, UK
| | - Frédéric Picard
- Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, Golden Jubilee National Hospital, UK
| | - Martin Sarungi
- Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, Golden Jubilee National Hospital, UK
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Shahi N, Arosemena M, Kwon J, DiMuzio P, Abai B, Salvatore DM. A rare case of Clostridium septicum aortitis with colon adenocarcinoma. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:87-90. [PMID: 29707691 PMCID: PMC5918140 DOI: 10.1016/j.jvscit.2017.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 12/16/2017] [Indexed: 11/26/2022]
Abstract
Clostridium septicum aortitis is a rare, highly morbid condition typically accompanied by malignant disease, such as hematologic cancer or colon adenocarcinoma. Presenting symptoms commonly described include acute onset of abdominal pain, nausea, and fevers. Prompt diagnosis of infectious aortitis is critical to prevent deadly complications, such as sepsis and vascular catastrophe. The described management largely involves surgical resection of the infected aorta, débridement, and arterial revascularization through extra-anatomic bypass or aortic graft placement.
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Affiliation(s)
- Niti Shahi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pa
| | - Mariano Arosemena
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pa
| | - Jeontaik Kwon
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pa
| | - Paul DiMuzio
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pa
| | - Babak Abai
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pa
| | - Dawn M Salvatore
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pa
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Ito F, Inokuchi R, Matsumoto A, Kumada Y, Yokoyama H, Ishida T, Hashimoto K, Narita M, Shinohara K. Presence of periaortic gas in Clostridium septicum-infected aortic aneurysm aids in early diagnosis: a case report and systematic review of the literature. J Med Case Rep 2017; 11:268. [PMID: 28931420 PMCID: PMC5607595 DOI: 10.1186/s13256-017-1422-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clostridium septicum-infected aortic aneurysm is a fatal and rare disease. We present a fatal case of C. septicum-infected aortic aneurysm and a pertinent literature review with treatment suggestions for reducing mortality rates. CASE PRESENTATION A 58-year-old Japanese man with an unremarkable medical history presented with a 3-day history of mild weakness in both legs, and experienced paraplegia and paresthesia a day before admission. Upon recognition of signs of an abdominal aortic aneurysm and paraplegia, we suspected an occluded Adamkiewicz artery and performed a contrast-enhanced computed tomography scan, which revealed an aortic aneurysm with periaortic gas extending from his chest to his abdomen and both kidneys. Antibiotics were initiated followed by emergency surgery for source control of the infection. However, owing to his poor condition and septic shock, aortic repair was not possible. We performed bilateral nephrectomy as a possible source control, after which we initiated mechanical ventilation, continuous hemodialysis, and hemoperfusion. A culture of the samples taken from the infected region and four consecutive blood cultures yielded C. septicum. His condition gradually improved postoperatively; however, on postoperative day 10, massive hemorrhage due to aortic rupture resulted in his death. CONCLUSIONS In this patient, C. septicum was thought to have entered his blood through a gastrointestinal tumor, infected the aorta, and spread to his kidneys. However, we were uncertain whether there was an associated malignancy. A literature review of C. septicum-related aneurysms revealed the following: 6-month mortality, 79.5%; periaortic gas present in 92.6% of cases; no standard operative procedure and no guidelines for antimicrobial administration established; and C. septicum was associated with cancer in 82.5% of cases. Thus, we advocate for early diagnosis via the identification of periaortic gas, as an aortic aneurysm progresses rapidly. To reduce the risk of reinfection as well as infection of other sites, there is the need for concurrent surgical management of the aneurysm and any associated malignancy. We recommend debridement of the infectious focus and in situ vascular graft with omental coverage. Postoperatively, orally administered antibiotics must be continued indefinitely (chronic suppression therapy). We believe that these treatments will decrease mortality due to C. septicum-infected aortic aneurysms.
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Affiliation(s)
- Fumihito Ito
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.
| | - Ryota Inokuchi
- Department of Emergency and Critical Care Medicine, JR General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan.,Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akinori Matsumoto
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Yoshibumi Kumada
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Hideyuki Yokoyama
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Tokiya Ishida
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Katsuhiko Hashimoto
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Masashi Narita
- Department of Infectious Diseases, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, 904-2293, Japan
| | - Kazuaki Shinohara
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
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Implications of Clostridium septicum in Vascular Surgery: A Case Report and Outcomes Literature Review. Ann Vasc Surg 2017; 43:314.e5-314.e11. [DOI: 10.1016/j.avsg.2017.03.178] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/28/2017] [Indexed: 11/22/2022]
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Shah A, Yousuf T, Rachid M, Ali N, Tabriz M, Loughry K. Clostridium septicum Aortitis of the Infrarenal Abdominal Aorta. J Clin Med Res 2015; 8:168-74. [PMID: 26767087 PMCID: PMC4701074 DOI: 10.14740/jocmr2435w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 12/31/2022] Open
Abstract
Clostridium septicum aortitis is a rare infection that has a strong association with occult colonic malignancy. There is also emerging evidence to support the combination of medical and surgical management over medical management alone. To the best of our knowledge, we report the 40th known case of C. septicum aortitis.
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Affiliation(s)
- Aditya Shah
- Advocate Christ Medical Center, 4440 W. 95th Street, Oak Lawn, IL 60453, USA
| | - Tariq Yousuf
- Advocate Christ Medical Center, 4440 W. 95th Street, Oak Lawn, IL 60453, USA
| | - Mohammed Rachid
- Advocate Christ Medical Center, 4440 W. 95th Street, Oak Lawn, IL 60453, USA
| | - Naureen Ali
- Advocate Christ Medical Center, 4440 W. 95th Street, Oak Lawn, IL 60453, USA
| | - Muhammad Tabriz
- Advocate Christ Medical Center, 4440 W. 95th Street, Oak Lawn, IL 60453, USA
| | - Kevin Loughry
- Advocate Christ Medical Center, 4440 W. 95th Street, Oak Lawn, IL 60453, USA
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8
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Eplinius F, Hädrich C. Acute aortic dissection caused by Clostridium septicum aortitis. Forensic Sci Int 2014; 244:e38-41. [PMID: 25242573 DOI: 10.1016/j.forsciint.2014.08.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/25/2014] [Accepted: 08/26/2014] [Indexed: 11/28/2022]
Abstract
Clostridium septicum aortitis is a rare cause of aortic dissection. So far, only 28 cases have been described in literature before. Most of these cases occurred in elderly patients and an association to colonic neoplasms and/or atherosclerosis has been witnessed frequently. Here we report the case of a 32-year-old man with fatal aortic dissection due to aortic infection with C. septicum. Beside a case of a 22-year-old man who died of aortic dissection due to C. septicum aortitis this is the second case of C. septicum aortitis in a young individual with no signs of colonic neoplasms or atherosclerosis.
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Affiliation(s)
- Franziska Eplinius
- Institute for Legal Medicine, University of Leipzig, Germany Johannisallee 28, 04103 Leipzig, Germany.
| | - Carsten Hädrich
- Institute for Legal Medicine, University of Leipzig, Germany Johannisallee 28, 04103 Leipzig, Germany.
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Krypciak S, Baudry E, Louis N, Mayer J, Taillandier-Heriche E, Laurent M, Allaire E, Paillaud E. Anévrisme mycotique de l’aorte à Clostridium septicum : à propos d’un cas et revue de la littérature. ACTA ACUST UNITED AC 2011; 36:355-63. [DOI: 10.1016/j.jmv.2011.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 08/18/2011] [Indexed: 12/27/2022]
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10
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Brook I. Anaerobic bacteria as a cause of mycotic aneurysm of the aorta: microbiology and antimicrobial therapy. Curr Cardiol Rev 2011; 5:36-9. [PMID: 20066146 PMCID: PMC2803286 DOI: 10.2174/157340309787048095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 07/26/2008] [Accepted: 07/26/2008] [Indexed: 11/22/2022] Open
Abstract
This review summarizes the microbiology, and antimicrobial management of mycotic aneurysm of the aorta (MAA) due to anaerobic bacteria. Anaerobic bacteria are an uncommon but important cause of MAA. Most cases of anaerobic MAA are caused anaerobic gram-negative bacilli (mostly B. fragilis group), Clostridium spp. (mostly Clostridium septicum, and Propionobacterium spp. (mostly P. acnes). Clostridial infection is frequently associated with gastrointestinal or hematologic malignancy. A review of all the reported cases is presented. Treatment of MAA involving anaerobic bacteria includes the use of antimicrobial effective against these organisms.
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Affiliation(s)
- Itzhak Brook
- Departments of Pediatrics and Medicine, Georgetown University School of Medicine, Washington DC, USA
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11
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Seder CW, Kramer M, Long G, Uzieblo MR, Shanley CJ, Bove P. Clostridium septicum aortitis: Report of two cases and review of the literature. J Vasc Surg 2009; 49:1304-9. [PMID: 19307090 DOI: 10.1016/j.jvs.2008.11.058] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Revised: 10/30/2008] [Accepted: 11/16/2008] [Indexed: 01/16/2023]
Abstract
Clostridium septicum aortitis is a rare infection that has a strong association with occult colonic malignancy. To our knowledge, we report the 25th and 26th cases of C septicum aortitis in the English literature and make recommendations for its management. The first patient was a 75-year-old man who presented with abdominal pain. Computed tomography showed the presence of periaortic gas. He underwent aortic débridement and extra-anatomic bypass after blood cultures revealed C septicum. Four months after the initial presentation, he was readmitted with lethargy, found to have recurrent periaortic gas, and died. The second patient was a 76-year-old woman who presented with a 5-cm abdominal aortic aneurysm with surrounding retroperitoneal gas. She underwent emergency aortic ligation and retroperitoneal débridement. Her blood and intraoperative tissue cultures also grew C septicum. She had a prolonged postoperative course and ultimately died on hospital day 94. Both patients were found to have concurrent colon adenocarcinomas. C septicum aortitis is a lethal disease that necessitates prompt surgical intervention and appropriate antibiotic therapy. The strong association of C septicum with occult malignancy should prompt the astute clinician to undertake an exhaustive search for a neoplastic process.
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12
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Hermsen JL, Schurr MJ, Kudsk KA, Faucher LD. Phenotyping Clostridium septicum infection: a surgeon's infectious disease. J Surg Res 2008; 148:67-76. [PMID: 18570933 DOI: 10.1016/j.jss.2008.02.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 02/05/2008] [Accepted: 02/12/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clostridium septicum infection is associated with malignancy. Whether disease phenotype is affected by malignant status is not known. Surgical treatment is used frequently but its impact on survival has not been examined in a cohort >30 patients. METHODS A PubMed search of English language journal articles yielded 320 cases. Full information (infection location, cancer type, operative intervention, and survival) was available for 224 cases + 7 at our institution not previously reported. RESULTS Seventy-two percent of patients had malignancy or malady of the gastrointestinal (GI) or hematologic (HEME) organ systems. HEME survival was inferior to GI survival (35% versus 55%, P = 0.03). Overall, patients who underwent operation had improved survival (57% versus 26%; P < 0.0001) and this association was maintained within GI and HEME cohorts (P = 0.002 and 0.005, respectively). More GI than HEME patients underwent operation (81% versus 51%, P < 0.001). GI patients were more likely than HEME patients to experience infection of skin and soft tissues (SSTI, P = 0.006). Diabetics were more likely to experience SSTI than nondiabetics (77% versus 45%, P < 0.001). CONCLUSIONS C. septicum infectious phenotype varies with host milieu. The SSTI phenotype is more common in GI and diabetic patients. This recognition may aid in directing the search for occult malignancy, which must be performed given the >70% incidence of concomitant cancer. This infection is more fatal in HEME versus GI patients, perhaps due in part to less HEME group operative intervention. Primary surgical therapy should be considered in GI or HEME patients as operative intervention benefits both groups.
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Affiliation(s)
- Joshua L Hermsen
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA.
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13
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Takano H, Taniguchi K, Kuki S, Nakamura T, Miyagawa S, Masai T. Mycotic aneurysm of the infrarenal abdominal aorta infected by Clostridium septicum: A case report of surgical management and review of the literature. J Vasc Surg 2003; 38:847-51. [PMID: 14560242 DOI: 10.1016/s0741-5214(03)00612-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a surgical case of mycotic aneurysm of the infrarenal abdominal aorta infected by Clostridium septicum. The patient was first treated with an in situ prosthetic graft replacement. When the infection recurred 5 weeks after the aortic surgery, the patient was successfully treated by transposition of rectus abdominis muscle flap around the graft. Only 19 cases of mycotic aneurysm or aortic dissection caused by Clostridium septicum have been reported. Ten of 12 patients who underwent vascular surgery survived, whereas all 7 patients who did not undergo surgery died. Surgical treatment should be undertaken since the surgical results seem satisfactory.
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Affiliation(s)
- Hiroshi Takano
- Department of Cardiovascular Surgery, Osaka Rosai Hospital, Osaka University Graduate School of Medicine, E1 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
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14
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Morrison RC, DiMuzio PJ, Kahn M, Carabasi RA, Bailey W, Edie RN. Clostridial mycotic aneurysm of the thoracoabdominal aorta--a case report. VASCULAR SURGERY 2001; 35:303-10. [PMID: 11586456 DOI: 10.1177/153857440103500410] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Clostridial infection of the aorta is a rare and life-threatening condition. The management of a mycotic aneurysm involving the thoracoabdominal aorta due to Clostridium septicum infection is presented. Successful surgical management of the aortic infection involved arterial resection, wide debridement of the surrounding tissues, and in situ graft replacement. Sixteen additional cases of clostridial infection of the aortoiliac segment reported in the literature are also summarized. In ten of these 17 cases, an associated colonic adenocarcinoma was documented.
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Affiliation(s)
- R C Morrison
- Division of Cardiothoracic Surgery, Department of Surgery, Jefferson Medical College, 111 South 11th Street, Philadelphia, PA 19107, USA
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15
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16
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Monsen T, Palmgren H, Arnerlöv C, Billheden J. Aortic dissection due to Clostridium septicum infection. Eur J Vasc Endovasc Surg 1997; 13:517-8. [PMID: 9166278 DOI: 10.1016/s1078-5884(97)80183-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- T Monsen
- Department of Clinical Bacteriology, University Hospital of Umeå, Sweden
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17
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Abstract
We describe a case-of a 78-year-old man who presented with a mycotic aneurysm of the thoracic aorta caused by Clostridium septicum and underwent successful resection. There are only 3 cases of mycotic aneurysms caused by Clostridium septicum reported in the literature. Clostridium septicum infections have been shown to have a high association with gastrointestinal and hematologic malignancies. All patients with Clostridium septicum infections, therefore, require a search for gastrointestinal lesions, as they may represent a source of persistent bacteremia. This patient had no malignant lesions but did have multiple benign sigmoid polyps.
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Affiliation(s)
- D P Murphy
- Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA
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18
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Sailors DM, Eidt JF, Gagne PJ, Barnes RW, Barone GW, McFarland DR. Primary Clostridium septicum aortitis: a rare cause of necrotizing suprarenal aortic infection. A case report and review of the literature. J Vasc Surg 1996; 23:714-8. [PMID: 8627911 DOI: 10.1016/s0741-5214(96)80055-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A 74-year old woman sought medical attention for general symptoms of nausea, vomiting, and back pain. A computed tomographic scan showed gas in the wall of the descending thoracic and suprarenal aortas. Emergency thoracoabdominal exploration revealed a necrotizing infection of the thoracic aorta extending to the origin of the celiac axis. After surgery Clostridium septicum was identified in tissue culture. Surgical management consisted of in-situ graft replacement of the thoracoabdominal aorta. Three months later, a pseudoaneurysm developed at the distal anastomosis. The patient refused further surgery and died 3 days later. The cause of death was presumed to be a ruptured mycotic aneurysm as a result of recurrent C. septicum infection. The relationship of C. septicum with occult gastrointestinal and hematologic malignancy has been documented. This patient represents the 10th reported case of C. septicum arteritis. Including the nine previous case reports of C. septicum arteritis, the mortality rate is 70%. When evaluating a patient with a mycotic aneurysm or aortitis, C. septicum should be considered. If it is found, a search should be carried out for an associated gastrointestinal or hematologic malignancy. Surgical repair should include extraanatomic revascularization and wide debridement of the infected field. Consideration should be given to lifelong antimicrobial therapy for this potentially fatal infection.
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Affiliation(s)
- D M Sailors
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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19
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Messa CA, Kulkarni M, Arous E. Double clostridial mycotic aneurysms of the aorta. CARDIOVASCULAR SURGERY (LONDON, ENGLAND) 1995; 3:687-92. [PMID: 8745194 DOI: 10.1016/0967-2109(96)82870-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Mycotic aortic aneurysm continues to present challenging and difficult management issues with a significant morbidity and mortality. The offending organism in the etiology of this aneurysm can be variable and unusual. The first report of two mycotic aortic aneurysms caused by Clostridium septicum in the same patient is described here. Presentation and management as well as conditions commonly associated with Clostridium septicum infection and a review of all clostridial mycotic aortic aneurysms in the English literature are discussed.
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Affiliation(s)
- C A Messa
- Department of Surgery, Medical Center of Central Massachusetts, Worcester, USA
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20
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Upchurch GR, Clair DG, Whittemore AD, Mannick JA. Clostridium septicum bacteremia associated with aortic graft infection. J Vasc Surg 1995; 22:493-5. [PMID: 7563411 DOI: 10.1016/s0741-5214(95)70019-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
After emergency repair of a ruptured abdominal aortic aneurysm associated with an aortocaval fistula, Clostridium septicum sepsis prompted evaluation for colon cancer. Adenocarcinoma of the right colon ultimately required hemicolectomy, after which the patient had development of recurrent C. septicum bacteremia. Computed tomography scanning demonstrated a large fluid collection surrounding the aortic graft, and percutaneous drainage documented recurrent C. septicum. Initial axillobifemoral bypass was followed by removal of the patient's aortic graft and retroperitoneal drainage. After 3 years the patient is without evidence of recurrent infection or tumor. This case report consists of a known instance of C. septicum infection of an aortic graft.
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Affiliation(s)
- G R Upchurch
- Department of Surgery, Harvard Medical School, Brigham & Women's Hospital, Boston, MA 02115, USA
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Sing TM, Young N, O'Rourke IC, Tomlinson P. Leaking mycotic abdominal aortic aneurysm. AUSTRALASIAN RADIOLOGY 1994; 38:310-2. [PMID: 7993259 DOI: 10.1111/j.1440-1673.1994.tb00206.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A case of leaking mycotic abdominal aortic aneurysm is reported, with a brief review of the literature. A 58 year old female presented with shoulder and abdominal pain associated with diarrhoea, vomiting and fever with leucocytosis. Computed tomography of the abdomen showed pooling of contrast in the retroperitoneum anterior to a non-dilated abdominal aorta. There was considerable retroperitoneal blood accumulating in a mass-like lesion in the right lower abdomen and pelvis obstructing the right renal collecting system. Laparotomy revealed a 4 cm diameter saccular aneurysm of the abdominal aorta, with a 1 cm diameter neck. Culture of the thrombus grew Streptococcus pyogenes.
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Affiliation(s)
- T M Sing
- Department of Radiology, Westmead Hospital, NSW, Australia
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Christensen J, Bistrup C. Case report: emphysematous pyelonephritis caused by clostridium septicum and complicated by a mycotic aneurysm. Br J Radiol 1993; 66:842-3. [PMID: 8220960 DOI: 10.1259/0007-1285-66-789-842] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- J Christensen
- Department of Diagnostic Radiology, Centralsygehuset i Esbjerg, Denmark
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