Surgical management of ruptured mycotic aortic aneurysm induced by Klebsiella pneumoniae

Kim, Sang Dong; Hwang, Jeong Kye; Moon, In Sung; Park, Sun Cheol

doi:10.1097/cm9.0000000000000021

Cited by 1 publication

(1 citation statement)

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“…Mycotic or infectious causes are the most common aetiologies for the development of SMA aneurysms, with Streptococci being the most reported cause followed by Staphylococci [4]. Klebsiella, the organism grown in the blood culture of our patient, has been reported in literature as a much rarer cause [5,6]. K. pneumoniae is a gram negative, encapsulated, non-motile bacterium [7] normally found as a part of the normal flora of human intestinal tract, but it is also an opportunistic pathogen [8] causing pneumonia, bacteraemia, and intra-abdominal infections [6].…”

Section: Discussionmentioning

confidence: 60%

Visceral Mycotic Aneurysm: Superior Mesenteric Artery Aneurysm Caused by K. pneumoniae

et al. 2021

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We herein report a rare case of mycotic aneurysm of the superior mesenteric artery caused by Klebsiella pneumoniae. A 66-year-old man, a known case of hypertension and aorto-oesophageal fistula with stented aorta in 2010 and 2018, presented to the emergency department multiple times over 2 months with severe postprandial abdominal pain associated with vomiting and fever. On his last presentation, the obtained blood cultures grew ESBL positive K. pneumoniae and a repeated computed tomography (CT) showed a growing aneurysm at the origin of the ileocecal branch of the superior mesenteric artery measuring 17 × 10 mm (the aneurysm was 8 × 7.5 mm in the CT angiography on the previous admission). Extensive workup did not reveal the underlying cause of the mycotic aneurysm, thus we believe the cause to be the infected aortic stent, leading to bacteraemia and vegetations to the mesenteric artery causing the aneurysm. The management plan was placed by a multidisciplinary team consisting of vascular surgeons and infectious disease specialists along with review from a dietician to evaluate the patient’s nutritional status. The patient was started on total parenteral nutrition due to his postprandial pain and on antibiotic therapy according to the infectious disease team’s recommendation. He underwent surgical resection of the mycotic aneurysm, which showed a thrombosed aneurysm in the jejunoileal mesenteric area. The histopathology of the resected tissue demonstrated inflammatory aneurysm of the mesenteric artery. Following the surgery, the patient continued his antibiotic therapy and was discharged on the 13th post-operative day with follow-up appointments in the vascular surgery and infectious disease clinic.

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