Superior mesenteric artery aneurysm in a patient with infective endocarditis

ABSTRACT Infective endocarditis (IE) is a rare but serious condition. We present a case of endocarditis in a healthy 40-year-old male with no predisposing conditions. His physical examination was suggestive of peripheral microembolization and prompted us to consider the diagnosis of IE and order the appropriate investigations. After treatment, he later presented to the emergency department with abdominal pain, and a superior mesenteric artery aneurysm was discovered. We discuss recent advances in the changing epidemiology and microbiology of IE, review the presentation and diagnosis of IE, and highlight the potential complications of this disease.

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Antibiotic Therapy Did Not Prevent the Rupture of Mycotic Aneurysm of the Superior Mesenteric Artery

The Heart Surgery Forum ◽

10.1532/hsf.1322 ◽

2015 ◽

Vol 18 (3) ◽

pp. 088

Author(s):

Ye-tao Li ◽

Xiao-bin Liu ◽

Tao Wang

Keyword(s):

Abdominal Pain ◽

Infective Endocarditis ◽

Aortic Valve ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Mycotic Aneurysm ◽

Acute Abdominal Pain ◽

Rare Complication ◽

Emergency Operation ◽

History Of

Mycotic aneurysm of the superior mesenteric artery (SMA) is a rare complication of infective endocarditis. We report a case with infective endocarditis involving the aortic valve complicated by multiple septic embolisms. The patient was treated with antibiotics for 6 weeks. During preparation for surgical treatment, the patient developed acute abdominal pain and was diagnosed with a ruptured SMA aneurysm, which was successfully treated with an emergency operation of aneurysm ligation. The aortic valve was replaced 17 days later and the patient recovered uneventfully. In conclusion, we present a rare case with infective endocarditis (IE) complicated by SMA aneurysm. Antibiotic treatment did not prevent the rupture of SMA aneurysm. Abdominal pain in a patient with a recent history of IE should be excluded with ruptured aneurysm.

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Superior mesenteric artery aneurysm: A rare cause of abdominal pain in pregnancy

Journal of Obstetrics and Gynaecology ◽

10.3109/01443619509030928 ◽

1995 ◽

Vol 15 (5) ◽

pp. 305-306

Author(s):

D. A. Bilalis ◽

R. C. Warren ◽

J. M. F. Clarke

Keyword(s):

Abdominal Pain ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Artery Aneurysm ◽

In Pregnancy

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Endovascular Repair of a Splenic Artery Aneurysm With Anomalous Origin From the Superior Mesenteric Artery

Vascular and Endovascular Surgery ◽

10.1177/1538574417690344 ◽

2017 ◽

Vol 51 (3) ◽

pp. 152-154 ◽

Cited By ~ 4

Author(s):

Lalithapriya Jayakumar ◽

Francis J. Caputo ◽

Joseph V. Lombardi

Keyword(s):

Abdominal Pain ◽

Superior Mesenteric Artery ◽

Endovascular Repair ◽

Mesenteric Artery ◽

Splenic Artery ◽

Artery Aneurysm ◽

Recurrent Abdominal Pain ◽

Anomalous Origin ◽

Splenic Artery Aneurysm ◽

History Of

A 22 year old female with a history of recurrent abdominal pain was transferred to our institution with a diagnosis of splenic artery aneurysm identified on imaging. CT angiography of the abdomen and pelvis revealed a partially thrombosed 3.0 cm splenic artery aneurysm without signs of rupture and with an anomalous origin from the superior mesenteric artery. The patient was successfully treated with endovascular exclusion of the aneurysm. Herein we review some of the nuances of endovascular repair of splenic artery aneurysm.

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Superior Mesenteric Artery Aneurysm Presenting with Chronic Abdominal Pain: A Case Report

Cardiovascular Journal ◽

10.3329/cardio.v8i2.26822 ◽

2016 ◽

Vol 8 (2) ◽

pp. 161-164

Author(s):

Mohammad Enamul Hakim ◽

MIS Al Manzo ◽

F Aaysha Cader ◽

Naresh Chandra ◽

Fidah Hossain

Keyword(s):

Abdominal Pain ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Artery Aneurysm ◽

Chronic Abdominal Pain ◽

Intestinal Bleeding ◽

High Morbidity ◽

Ptfe Graft ◽

Risk Of Rupture ◽

Wide Range

Superior mesenteric artery (SMA) aneurysm is a rare vascular entity and may present with a wide range of symptoms. They are often symptomatic, presenting with thromboembolic intestinal angina. They have a high risk of rupture and may present with gastro-intestinal bleeding, associated with high morbidity and mortality. We report the case of a 14year-old boy who presented with chronic abdominal pain and weight loss, in which SMA aneurysm was diagnosed after radiological evaluation. He underwent successful excision of aneurysmal sac along with aorto-mesenteric bypass using polytetrafluoroethylene (PTFE) graft, and had an uneventful recovery.Cardiovasc. j. 2016; 8(2): 161-164

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Malrotation Induced Small Intestine Ischemia in an Adolescent

Case Reports in Surgery ◽

10.1155/2017/4809406 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Karadeniz Erdem ◽

Atamanalp Selçuk Sabri

Keyword(s):

Emergency Department ◽

Small Intestine ◽

Abdominal Pain ◽

Superior Mesenteric Artery ◽

Emergency Surgery ◽

Mesenteric Artery ◽

Duodenal Obstruction ◽

Mesenteric Ischemia ◽

Clockwise Rotation ◽

Small Intestinal

Intestinal malrotation occurs if midgut does not complete or partially completes its 270° counter-clockwise rotation around the superior mesenteric artery during embryologic life. In general, it frequently manifests with vomiting due to duodenal obstruction and volvulus in the initial months of life, and it is very rare to manifest in the adulthood. A 20-year-old male patient who had severe abdominal pain, nausea, vomiting, and distention for one day was evaluated at the emergency department. On abdominal tomography “swirling appearance of structures around the superior mesenteric artery” was reported. CT appearance was considered compatible with a rotational anomaly. Emergency surgery was planned for the patient. In laparotomy, it was observed that an approximately 100 cm long small intestine segment was rotated around a band (Ladd) and ischemia was developed in this segment due to rotation of its mesentery. The rotation of the small intestinal mesentery was corrected by opening the bands. After the warm application to the intestinal mesenteric ischemia for a while, the color and the peristalsis of the intestines became normal. The patient was discharged on postoperative day 2 with suggestions.

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Simultaneous Valve Replacement and Venous Patch Repair of Superior Mesenteric Artery Aneurysm Due to Infective Endocarditis: A Case Report

The Heart Surgery Forum ◽

10.1532/hsf98.20061029 ◽

2006 ◽

Vol 9 (5) ◽

pp. E741-E743 ◽

Cited By ~ 2

Author(s):

Filip Rega ◽

André Nevelsteen ◽

Willy Peetermans ◽

Marie-Christine Herregods ◽

Willem Flameng ◽

...

Keyword(s):

Case Report ◽

Infective Endocarditis ◽

Superior Mesenteric Artery ◽

Valve Replacement ◽

Mesenteric Artery ◽

Artery Aneurysm ◽

Patch Repair ◽

Venous Patch

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Isolated superior mesenteric artery dissection in the emergency department: A rare cause of abdominal pain

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2018.09.033 ◽

2018 ◽

Vol 36 (12) ◽

pp. 2341.e1-2341.e2

Author(s):

Ömer Salt ◽

Mustafa Burak Sayhan ◽

Eren Duyar

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Artery Dissection ◽

Superior Mesenteric Artery Dissection

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Synchronous celiac axis and superior mesenteric artery embolism

VASA ◽

10.1024/0301-1526/a000154 ◽

2011 ◽

Vol 40 (6) ◽

pp. 495-498 ◽

Cited By ~ 1

Author(s):

Rajkovic ◽

Zelic ◽

Papes ◽

Cizmek ◽

Arslani

Keyword(s):

Atrial Fibrillation ◽

Small Intestine ◽

Abdominal Pain ◽

Ct Scan ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Abdominal Cavity ◽

Celiac Axis ◽

Contrast Administration ◽

Artery Embolism

We present a case of combined celiac axis and superior mesenteric artery embolism in a 70-year-old patient that was examined in emergency department for atrial fibrillation and diffuse abdominal pain. Standard abdominal x-ray showed air in the portal vein. CT scan with contrast showed air in the lumen of the stomach and small intestine, bowel distension with wall thickening, and a free gallstone in the abdominal cavity. Massive embolism of both celiac axis and superior mesenteric artery was seen after contrast administration. On laparotomy, complete necrosis of the liver, spleen, stomach and small intestine was found. Gallbladder was gangrenous and perforated, and the gallstone had migrated into the abdominal cavity. We found free air that crackled on palpation of the veins of the gastric surface. The patients condition was incurable and she died of multiple organ failure a few hours after surgery. Acute visceral thromboembolism should always be excluded first if a combination of atrial fibrillation and abdominal pain exists. Determining the serum levels of d-dimers and lactate, combined with CT scan with contrast administration can, in most cases, confirm the diagnosis and lead to faster surgical intervention. It is crucial to act early on clinical suspicion and not to wait for the development of hard evidence.

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Visceral Mycotic Aneurysm: Superior Mesenteric Artery Aneurysm Caused by K. pneumoniae

Dubai Medical Journal ◽

10.1159/000517222 ◽

2021 ◽

pp. 1-4

Author(s):

Reham Almasoud ◽

Alaaeddin Nwilati ◽

Saeb Bayazid ◽

Mamoun Shafaamri

Keyword(s):

Infectious Disease ◽

Antibiotic Therapy ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Mycotic Aneurysm ◽

Artery Aneurysm ◽

Management Plan ◽

Resected Tissue ◽

Infectious Disease Specialists

We herein report a rare case of mycotic aneurysm of the superior mesenteric artery caused by Klebsiella pneumoniae. A 66-year-old man, a known case of hypertension and aorto-oesophageal fistula with stented aorta in 2010 and 2018, presented to the emergency department multiple times over 2 months with severe postprandial abdominal pain associated with vomiting and fever. On his last presentation, the obtained blood cultures grew ESBL positive K. pneumoniae and a repeated computed tomography (CT) showed a growing aneurysm at the origin of the ileocecal branch of the superior mesenteric artery measuring 17 × 10 mm (the aneurysm was 8 × 7.5 mm in the CT angiography on the previous admission). Extensive workup did not reveal the underlying cause of the mycotic aneurysm, thus we believe the cause to be the infected aortic stent, leading to bacteraemia and vegetations to the mesenteric artery causing the aneurysm. The management plan was placed by a multidisciplinary team consisting of vascular surgeons and infectious disease specialists along with review from a dietician to evaluate the patient’s nutritional status. The patient was started on total parenteral nutrition due to his postprandial pain and on antibiotic therapy according to the infectious disease team’s recommendation. He underwent surgical resection of the mycotic aneurysm, which showed a thrombosed aneurysm in the jejunoileal mesenteric area. The histopathology of the resected tissue demonstrated inflammatory aneurysm of the mesenteric artery. Following the surgery, the patient continued his antibiotic therapy and was discharged on the 13th post-operative day with follow-up appointments in the vascular surgery and infectious disease clinic.

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