[A case of abdominal aortic pseudoaneurysm due to Salmonella enteritidis septicemia].
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A 66-year-old man suffering from high fever and abdominal pain was diagnosed as abdominal aortic pseudoaneurysm due to Salmonella enteritidis septicemia. After complete remission of infection with the antibiotic therapy, we performed a replacement of abdominal aorta with a prosthetic graft. Infection parameters are normal 5 months postoperatively. Although Salmonella septicemia is a serious disorder, it is not a rare infection recently as compromised host increases more. Rapid diagnosis, adequate antibiotic therapy and surgical treatment are essential for successful result of Salmonella aortic aneurysm.Keywords:
Salmonella enteritidis
Pseudoaneurysm
Abdominal aorta
Salmonella infection
Antibiotic Therapy
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A 66-year-old man suffering from high fever and abdominal pain was diagnosed as abdominal aortic pseudoaneurysm due to Salmonella enteritidis septicemia. After complete remission of infection with the antibiotic therapy, we performed a replacement of abdominal aorta with a prosthetic graft. Infection parameters are normal 5 months postoperatively. Although Salmonella septicemia is a serious disorder, it is not a rare infection recently as compromised host increases more. Rapid diagnosis, adequate antibiotic therapy and surgical treatment are essential for successful result of Salmonella aortic aneurysm.
Salmonella enteritidis
Pseudoaneurysm
Abdominal aorta
Salmonella infection
Antibiotic Therapy
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During a 5-year period, from 1990 to 1994, 61 patients underwent prosthetic reconstruction of aorto-iliac district for aneurysmal (53 cases) or obstructive (8 cases) disease. There was no postoperative mortality; 3 cases of early perianastomotic thrombosis, 2 cases of left colon necrosis, 4 cases of femoral pseudoaneurysm and 5 cases of sexual disfunction were recorded. If accurately performed, the surgery of this arterial district offers very good early and late results.
Pseudoaneurysm
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To report surgical experience in pseudoaneurysm (PA) repair of arteriovenous fistula (AVF) for renal hemodialysis.Twenty patients undergoing PA repair of AVF for renal hemodialysis were treated in Central Hospital Conde S. Januario of Macao. Sixteen patients had PAs of AVF in upper extremities, 4 in lower extremities. All patients were treated with surgical therapy.All operations were finished without death. One patient suffered from acute thrombosis, recovered without any complication through instant thrombectomy. One patient with postoperative incision bleeding recovered after low molecular weight heparin was ceased. And one AVF could not be mature six weeks later, was recovered after ligation of branch vein. And one patient died due to recurrent cerebral infarction.Surgical repair is the best choice for PA of AVF for renal hemodialysis.
Pseudoaneurysm
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Abdominal aorta
Inferior mesenteric artery
Internal iliac artery
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After multiple revisions of her right hip arthroplasty, an 83-year-old woman developed deep infection with a chronic draining sinus. In August 2002 severe acute bleeding occurred through this fistula. Angiography revealed a pseudoaneurysm of the right external iliac artery. Because of the multiple pathologies affecting this ASA grade IV patient, conventional surgical treatment was considered to be contra-indicated, and a stent was placed percutaneously under fluoroscopic control to seal the vascular laceration. No haematoma and no further bleeding was observed on the control CT-scan or at angiography. However the patient died with terminal renal failure forty days later. The case reported shows a rare complication of total hip arthroplasty. The method used in this case to seal the leakage, using a covered stent, is uncommon but effective in cases where conventional surgery is contra-indicated.
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V. O. Bubalo L. V. Gromashevskiy Institute of Epidemiology and Infectious Diseases of Academy of Medical Sciences of Ukraine (Kyiv) In this article the main results of the sensitivity to antibiotics on S. Typhimurium, S. strains of Salmonella Enteritidis and rare groups that circulate in Ukraine last 10 years were described. The unifying disc-fusion method determined the sensitivity of Salmonella strains to several antibiotics. Resistance to antibiotics of strains of Salmonella was caused by the lack of effective influence of drugs on salmonellosis. The obtained results revealed antibiotics with a strong antimicrobial action and a narrow focus on strains of Salmonella. KEY WORDS: salmonellosis, S. Typhimurium, S. Enteritidis, rare Salmonella strains, antibiotics ЧУТЛИВІСТЬ ДО АНТИБІОТИКІВ СЕРЕД АКТУАЛЬНИХ ШТАМІВ САЛЬМОНЕЛ, ЩО ЦИРКУЛЮЮТЬ НА ТЕРИТОРІЇ УКРАЇНИ ОСТАННІ 10 РОКІВ В. О. Бубало Інститут епідеміології та інфекційних хвороб ім. Л. В. Громашевського АМН України (Київ) У статті визначені основні результати дослідження на чутливість до антибіотиків щодо S. Typhimurium, S. enteritidis та штамів сальмонел рідких груп, що циркулюють на території України останні 10 років. За уніфікованим дискодифузійним методом була визначена чутливість штамів сальмонел до ряду антибіотиків. Резистентність штамів сальмонели до антибіотиків була викликана відсутністю ефективного впливу ліків на сальмонельоз. Отриманi результати дозволили виявити антибіотики з вираженою протимікробною дією і вузькою спрямованістю на штами сальмонели. КЛЮЧОВІ СЛОВА: сальмонельоз, S. Typhimurium, S. Enteritidis, штами сальмонел рідких груп, антибіотики ЧУВСТВИТЕЛЬНОСТЬ К АНТИБИОТИКАМ СРЕДИ АКТУАЛЬНЫХ ШТАММОВ САЛЬМОНЕЛЛ, ЦИРКУЛИРУЮЩИХ НА ТЕРРИТОРИИ УКРАИНЫ ПОСЛЕДНИЕ 10 ЛЕТ В. А. Бубало Институт эпидемиологии и инфекционных болезней им. Л. В. Громашевского АМН Украины (Киев) В статье определены основные результаты исследования на чувствительность к антибиотикам по S. Typhimurium, S. Enteritidis и штаммов сальмонелл редких групп, циркулирующих на территории Украины последние 10 лет. Унифицированным дискодифузийним методом была определена чувствительность штаммов сальмонелл к ряду антибиотиков. Резистентность штаммов сальмонеллы к антибиотикам была вызвана отсутствием эффективного воздействия лекарств на сальмонеллез. Полученные результаты позволили выявить антибиотики с выраженной противомикробным действием и узкой направленностью на штаммы сальмонеллы. КЛЮЧЕВЫЕ СЛОВА: сальмонеллез, S. Typhimurium, S. Enteritidis, штаммы сальмонелл редких групп, антибиотики Bubalo V. O., 2013
Salmonella enteritidis
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Abdominal aorta
Pseudoaneurysm
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A 67-year-old woman was admitted for severe abdominal pain (stomach ache). Computed tomography (CT) revealed gas along the abdominal aortic wall. A blood culture was positive for Salmonella dublin, a gram-negative bacillus that is rare in humans. Treatment with an antibiotic improved the inflammatory signs; however, on the 11th hospital day, the patient complained of sudden severe abdominal pain. Enhanced CT revealed a pseudoaneurysm surrounded by a periaortic abscess. The infected aortic wall, including the aneurysm, was resected and an extra-anatomic bypass was constructed between the axillary artery and the external iliac arteries. The patient recovered fully and her course has been uneventful for the past two years since her discharge.
Aortitis
Abdominal aorta
Pseudoaneurysm
Common iliac artery
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Primary infection of the abdominal aorta is a rare pathology that may threaten the integrity of the aortic wall, while secondary aortic prosthesis infection represents a devastating complication to open surgical and endovascular aortic surgery. Curative treatment is achievable by removal of all infected prosthetic material followed by a vascular reconstruction.Twelve consecutive patients treated with the neo-aortoiliac system bypass (NAIS) procedure were reviewed. Nine were treated for a secondary aortic prosthesis infection (tube graft n = 3, bifurcated graft n = 4, endovascular aortic repair (EVAR) stent graft n = 1, and fenestrated EVAR [FEVAR] stent graft n = 1), while 3 patients underwent NAIS repair due to an emergent primary mycotic aortoiliac aneurysm.Ten of 12 patients survived 30 days. Three patients were operated on acutely, and 9 patients had elective or subacute NAIS surgery. Two of 3 patients operated acutely died within 30 days, whereas no 30-day or 1-year mortality was observed in patients undergoing elective or subacute surgery. The median time from primary reconstruction to the NAIS procedure was 11 months (range: 0-201 months). Stent grafts (n = 5 of 12) were in 4 cases explanted using endovascular balloon clamping. Of the explanted endografts, 2 patients presented with a secondary graft infection after EVAR/FEVAR, while 3 patients had been emergently treated with endovascular cuffs as a "bridge-to-surgery" procedure due to aortoenteric fistula (AEF). Patients who received a "bridge-to-surgery" regimen were treated with the NAIS procedure within 8 weeks (median 27 days, range: 27-60) after receiving emergency stent grafting.Aortic balloon-clamping during explantation of infected aortic prosthetic endografts is feasible and facilitates complete endograft removal. Endovascular bridging procedures could be beneficiary in the treatment of AEF or anastomotic dehiscence due to graft infection, offering a possibility to convert the acute setting to an elective definitive reconstructive procedure with a higher overall success rate.
Aortoiliac occlusive disease
Aortoenteric Fistula
Pseudoaneurysm
Abdominal aorta
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Endovascular repair of abdominal aortic aneurysms continues to evolve as an alternative to open repair. After open aortic grafting, re-operation to repair anastomotic pseudoaneurysms is associated with significant morbidity and mortality. We reviewed our experience with the repair of para-anastomotic aortic pseudoaneurysms, including the feasibility of endovascular repair, its technical success, and outcome compared with conventional surgery. During a 10-year period, 11 patients (10 men, 1 woman) had repair of a para-anastomotic pseudoaneurysm (mean 7 cm; diameter range, 4.5-9 cm) involving the infrarenal aorta. Four pseudoaneurysms developed after infrarenal aortic aneurysm repairs and 7 after bypass for occlusive disease. The mean time to aneurysm development was 6 years. The decision for surgical (interposition polyester grafting) versus endovascular therapy was based on aortic anatomy, endograft availability, and surgeon preference. Endovascular repair was feasible and technically successful in 5 patients. All but one patient treated after the introduction of endovascular aneurysm repair at our institution (December 1999) was treated by this technique. Blood loss was significantly greater in the open surgical group (3000 mL vs 300 mL). The mean intensive care unit and hospital stay (days) was less in the endovascular group (0.8, 2.8) than in the surgical (4, 11) group. Thirty-day morbidity was similar for both treatment groups (endovascular, 1; surgery, 1), and no patient died in either group. During a mean follow-up of 20 months (range, 5-42 months), aortic imaging demonstrated one type II endoleak; which was successfully treated by translumbar embolization, and aneurysm diameter reduction in all endovascularly treated patients. During the surveillance period, no clinical signs of graft infection or recurrent aneurysm were evident in any patient in either treatment group. Endovascular repair of aortic graft para-anastomotic pseudoaneurysms is feasible and associated with more favorable outcomes than open surgical repair. When the aortic anatomy indicated endovascular therapy was a treatment option, endovascular repair was preferred by the surgeon and patient because of perceived reduced morbidity and shorter hospitalization than conventional surgery. To date, endovascular repair of aortic para-anastomotic pseudoaneurysms has produced durable results.
Aortic repair
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