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ISOLATED LEFT INTERNAL ILIAC ARTERY MYCOTIC ANEURYSM PRESENTED AS A LARGE RETROPERITONEAL HEMATOMA-A CASE REPORT
MOHAMED S. MAHBOOB ALI;
ADVANCED MEDICAL AND DENTAL INSTITUTE(AMDI), GEORGETOWN, Malaysia
Mycotic aneurysm is very rare in the new era of antibiotics. Commonest micro-organism that is associated with this pathology is Salmonella species. The predilection of salmonella species for the arterial wall is due to the pre-existing atherosclerotic plaques or ulcerations that disturbed the intimal layer of the vessel.
INTRODUCTIONWith the discoveries of endovascular stents the mortality from open surgery has went down. There were cases reported where these endovascular stents been infected and resulting in severe complications and ultimately needs removal.
CASE REPORTA 55 years old gentleman was referred to our center with the complaint of progressive left lower abdominal pain and swelling, fever with weakness of left lower limb. Blood culture grew salmonella species and patient was started on intravenous Cefoperazone. Clinically there was a pulsatile swelling (15x15) cm at the left side of the abdomen. CT angiography showed a left internal iliac artery aneurysm sized (6.5x4.0) cm with internal thrombus. Retroperitoneal hematoma was
evacuated, necrotic tissues debrided and the left common iliac vessel ligated. Histopathology showed fragments of cellular debris with fibro-collagenous tissue and moderate infiltrations by lympho-plasma cells.
DISCUSSIONMycotic aneurysm is a focal dilatation of a blood vessel due to salmonella species.Expansile swelling with pulsation and a positive blood culture is diagnostic. Laboratory findings are leukocytosis, elevated C-reactive proteins, ESR and neutrophil counts. CT-tomography is the choice of imaging that is used in diagnosing a mycotic aneurysm.
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