Emphysematous Abdominal Aortic Aneurysm by Clostridium septicum with Synchronous Colon Cancer

Abstract

Introduction: Clostridium septicum (C. septicum) aortitis is a rare condition frequently associated with colon adenocarcinoma and carries a poor prognosis. Case Report: We report the case of an 80-year-old man who was waiting for an elective endovascular repair of an abdominal aortic aneurysm (AAA) with a diameter of 5.8 × 5.4 cm. He underwent a colonoscopy because of a thickening of the colon wall in the preoperatory CT. One week after that, he presented at the emergency with a 48-hour duration of fever and abdominal pain. Abdominal CT imaging revealed an increased aneurysm size to 6.1 × 6.6 cm including gas within the aorta. Treatment consisted of antibiotics, urgent axillar to femoro-femoral bypass, excision and ligation of the infrarenal aorta and right hemicolectomy with end-ileostomy. Aortic cultures were positive for C. septicum. The postoperative was complicated by renal failure and the patient died. Conclusion: C. septicum-infected aortic aneurysm is a rare entity that is strongly associated with colon cancer. The presence of gas within the aorta or emphysematous aortitis is the most common sign of C. septicum infection. Broad-spectrum antibiotics should be initiated and emergency surgical management with excision of the infected aneurysm and grafting is required.

Antibiotic resistance and biofilm‐forming ability of α‐toxin‐positiveClostridium septicumisolates worsen patient prognosis

“…In general, a weakened immune system is associated with a poorer prognosis for infection, especially in the case of primary or secondary immunodeficiency. Colon cancer, ulceration of the colonic mucosa, leukemia, neutropenia, lymphoproliferative disorders, chemotherapy and radiotherapy, AIDS, and gastrointestinal surgery have been reported as risk factors for the development of spontaneous gas gangrene myonecrosis [15][16][17][18]. Patients with these diagnoses are susceptible to bacterial translocation to the bloodstream through a damaged or defect-free gastrointestinal wall.…”