title: Clostridium septicum aortitis: Report of two cases and review of the literature.
abstract: Clostridium septicum aortitis is a rare infection that has a strong association with occult colonic malignancy. To our knowledge, we report the 25th and 26th cases of C septicum aortitis in the English literature and make recommendations for its management. The first patient was a 75-year-old man who presented with abdominal pain. Computed tomography showed the presence of periaortic gas. He underwent aortic débridement and extra-anatomic bypass after blood cultures revealed C septicum. Four months after the initial presentation, he was readmitted with lethargy, found to have recurrent periaortic gas, and died. The second patient was a 76-year-old woman who presented with a 5-cm abdominal aortic aneurysm with surrounding retroperitoneal gas. She underwent emergency aortic ligation and retroperitoneal débridement. Her blood and intraoperative tissue cultures also grew C septicum. She had a prolonged postoperative course and ultimately died on hospital day 94. Both patients were found to have concurrent colon adenocarcinomas. C septicum aortitis is a lethal disease that necessitates prompt surgical intervention and appropriate antibiotic therapy. The strong association of C septicum with occult malignancy should prompt the astute clinician to undertake an exhaustive search for a neoplastic process.
authors.affiliation: Department of Surgery, Section of General, Royal Oak, Mich., USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Seder
authors.forename: Michael
authors.initials: M
authors.lastname: Kramer
authors.forename: Graham
authors.initials: G
authors.lastname: Long
authors.forename: Maciej R
authors.initials: MR
authors.lastname: Uzieblo
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Shanley
authors.forename: Paul
authors.initials: P
authors.lastname: Bove
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000473:pathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D001025:Aortitis / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D019917:Blood Vessel Prosthesis Implantation; D003015:Clostridium Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D052557:Clostridium septicum / Q000302:isolation & purification*; D003110:Colonic Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D003646:Debridement; D013505:Digestive System Surgical Procedures; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents