title: Repetitive contained rupture of an infected abdominal aortic aneurysm with concomitant vertebral erosion.
abstract: We describe a rare case of surgical treatment for a repeated contained rupture of an infected abdominal aortic aneurysm (AAA) with concomitant vertebral erosion. A 59-year-old man presented to a nearby hospital with abdominal pain and fever. On admission, computed tomography (CT) scan revealed a contained rupture of AAA, but the patient declined the offer of surgical therapy. Thereafter, the retroperitoneal hematoma gradually reduced in size. The third and fourth lumbar vertebrae were eroded on the CT scan 12 months after the appearance of the first symptom. However, 21 months after the first symptom, he suffered severe lumbago and was diagnosed with recurrence of contained AAA rupture and vertebral body destruction. He underwent debridement of eroded vertebrae and in situ graft replacement of AAA with omentum flap wrapping. Intraoperative microscopic examination of the hematoma revealed gram-positive Streptococcus. His postoperative course was uneventful, and CT 12 months after surgery did not reveal further deterioration of vertebral erosion or fluid accumulation. Repetitive contained AAA rupture may be another entity in contrast to chronic contained AAA rupture. Vertebral erosion could be associated with infection rather than mass effects of the contained hematoma. Surgical treatment is indicated to prevent life-threatening re-rupture and severe spinal instability.
authors.affiliation: Department of Cardiovascular Surgery, Akita University School of Medicine, Hondo 1-1-1, Akita, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Fumio
authors.initials: F
authors.lastname: Yamamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Izumoto
authors.forename: Fuminobu
authors.initials: F
authors.lastname: Tanaka
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Ishibashi
mesh_terms: D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation; D003646:Debridement; D006406:Hematoma / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery; D006801:Humans; D017116:Low Back Pain / Q000382:microbiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000601:surgery; D019637:Orthopedic Procedures; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D013524:Surgical Flaps; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents