Recognition and Management of Ruptured Infected Aneurysm of the Abdominal Aorta

A patient with a ruptured abdominal aortic aneurysm with clostridial infection was successfully managed by oversewing the aorta, debridement, and axillobifemoral bypass. Infected aneurysms of the abdominal aorta may present a confusing clinical picture, causing a delay in correct diagnosis. A history of fever and a palpable aneurysm should suggest the diagnosis. In obese individuals, abdominal roentgenograms and sonography may be helpful in establishing the presence of an aneurysm. Aortography may support the diagnosis of infection by the presence of a lobulated saccular aneurysm. Occasionally, the operative appearance of the aorta may be the only indica tion of an infected aortic aneurysm. The decision to oversew the aorta and perform an extra-anatomic bypass as the initial surgical procedure is essential for the proper management of these patients.