Mycotic Aneurysm of the Hepatic Artery: A Case Report and its Management

Abstract

Cholecystectomies are one of the most common surgical procedures performed in the United States, with complications being relatively common. We submit a case of a ruptured mycotic aneurysm of the hepatic artery, a complication of a recent cholecystectomy which was successfully treated with the use of transarterial thrombin.

Aneurisma infeccioso primário da aorta: série de casos e revisão da literatura

“… 6 , 12 , 18 The source of infection is not identified in 1/3 of cases and the etiologic agent is not established in 20-40% of cases. 11 , 14 , 15 Infectious aneurysms can be caused by contiguity 21 or, frequently, by bacteremia. 1 , 2 , 5 , 11 , 14 , 17 , 19 After attaching to the artery wall, the microorganism provokes acute inflammation with neutrophilic infiltration, leading to activation of enzymes and weakening of the artery wall, 8 resulting in suppuration and arterial dilatation.…”

“…1 , 4 , 5 , 8 , 9 , 11 , 12 , 14 , 17 , 24 Hepatic and splenic abscesses should be sought on tomography. 9 , 21 Echocardiography is a convenient method for investigating endocarditis. 4 Positron emission tomography/computed tomography scanning (PET-CT SCAN) is a tool with high diagnostic accuracy and very good sensitivity, but its specificity is affected by false-positive results in cases of inflammatory aneurysms and arterites.…”

“…There is no consensus on how to define the primary infectious etiology of these aneurysms. 5 , 15 , 17 It is suggested that diagnosis is based on the combination of clinical status, laboratory tests, and tomographic findings 1 , 6 , 12 , 17 , 21 ( Table 1 ). It is essential to be clear that this diagnosis can be made in the absence of fever and positive blood cultures.…”

“…Surgical treatment can be with endovascular procedures or conventional surgery. 1 , 3 , 6 , 7 , 9 , 14 , 15 , 21 , 23 Endovascular treatment of infectious aneurysms of the thoracic aorta was described in 1998. 25 Since then, several other reports have been published.…”

“… 25 Since then, several other reports have been published. 1 , 3 , 6 , 8 , 12 , 15 , 21 , 23 This strategy is less invasive because it avoids dissections in an anatomy compromised by infection and the aorta is not clamped, which in theory benefits patients with a high surgical risk. 1 , 7 , 11 However, implantation of endoprostheses in infected tissues increases the incidence of complications, including endoprosthesis infection, 1 , 6 , 9 , 23 and also of malpositioning and consequent endoleaks with the potential for aneurysm rupture.…”