Hartman V, Jiang H, Thomas B
Acta Chir Belg. 2009 Nov-Dec;109(6):788-90. doi: 10.1080/00015458.2009.11680539.
A 73-year-old man was admitted to the emergency department presenting with cramping pain in the left iliac fossa that had persisted for ten days, with diarrhoea and dysuria. A recent onset of high fever had urged him to the hospital. A routine blood sample showed a leukocytosis of 11.9 x 10(3)/mm(3) and an elevated CRP of 16 mg/dl. Haemocultures and a urine sample were taken. A colonoscopy and ultrasound showed no abnormalities. The urine culture contained salmonella enteritidis. On day 5 a CT scan of the abdomen was performed. This showed a saccular aneurysm of the abdominal aorta, approximately 2 cm in length, with clear signs of a contained rupture. An urgent EVAR procedure was performed. An Excluder bifurcation-endoprosthesis was placed under antibiotic coverage. Control CT scan showed a thrombosis of the aneurysm and a type II endoleakage. The endoleakage spontaneously resolved within 3 months. The patient was kept on antibiotics (levofloxacine) for 4 months. We suggest that the use of an endoprosthesis could be a good and safe alternative for the repair of infrarenal mycotic aorta aneurysm.
一名73岁男性因左下腹绞痛持续10天，伴有腹泻和排尿困难被收入急诊科。近期出现的高热促使他前来就医。常规血液样本显示白细胞增多，为11.9×10(3)/mm(3)，C反应蛋白升高至16mg/dl。采集了血培养样本和尿液样本。结肠镜检查和超声检查均未发现异常。尿液培养发现肠炎沙门氏菌。第5天进行了腹部CT扫描。结果显示腹主动脉有一个囊状动脉瘤，长约2厘米，有明确的局限性破裂迹象。紧急进行了腔内修复术（EVAR）。在抗生素覆盖下放置了Excluder分叉型腔内移植物。对照CT扫描显示动脉瘤血栓形成和II型内漏。内漏在3个月内自行消失。患者接受了4个月的抗生素（左氧氟沙星）治疗。我们认为，使用腔内移植物可能是修复肾下腹主动脉感染性动脉瘤的一种安全有效的替代方法。
