title: Infectious anastomotic pseudoaneurysm complicating renal allograft: case report and review of literature.
abstract: Infectious anastomotic pseudoaneurysm complicating renal transplant is rare, but probably under-reported with <30 cases worldwide. We report a 45-year-old man with hypertension, diabetes mellitus and end stage renal failure, who had a renal transplant anastomosed to the right external iliac artery and vein. Postoperatively, he made a slow recovery with malaise and persistent vague right iliac fossa discomfort. Ultrasound scan 1 month postoperatively showed perinephric collection, and fluid culture grewEnterococcus faeciumandPseudomonas aeruginosa. He was started on vancomycin, daptomycin and colistin. MAG-3 scan also showed suboptimal function in the renal allograft. His symptoms persisted with fever, and blood culture yieldedP. aeruginosa.Repeated ultrasound scan, and subsequent computed tomography scan a few weeks later, showed perinephric collection and a large, 3.8×3.5 cm pseudoaneurysm posteromedial to the graft kidney. He underwent emergency graft excision, together with resection of the pseudoaneurysm with in situ reversed great saphenous vein interposition graft, and made a good recovery on hemodialysis. The aneurysm wall grewP. aeruginosa, and he was put on imipenem and cilastatin (tienam), colistin, ciprofloxacin and daptomycin. To our knowledge, this is one of very few cases in the world's literature in which aP. aeruginosainfectious anastomotic pseudoaneurysm developed after a renal allograft.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
authors.forename: Marvin Mt
authors.initials: MM
authors.lastname: Chung
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
authors.forename: Yiu Che
authors.initials: YC
authors.lastname: Chan
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
authors.forename: Yuk
authors.initials: Y
authors.lastname: Law
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
authors.forename: Stephen Wk
authors.initials: SW
authors.lastname: Cheng
keywords: in situ interposition bypass graft; infectious anastomotic pseudoaneurysm; multidrug-resistant Pseudomonas aeruginosa; renal allograft artery; renal transplant