Repetitive contained rupture of an infected abdominal aortic aneurysm with concomitant vertebral erosion. 2010

Hiroshi Yamamoto, and Fumio Yamamoto, and Hiroshi Izumoto, and Fuminobu Tanaka, and Kazuyuki Ishibashi
Department of Cardiovascular Surgery, Akita University School of Medicine, Hondo 1-1-1, Akita, Japan.

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.

UI MeSH Term Description Entries
D008159 Lumbar Vertebrae VERTEBRAE in the region of the lower BACK below the THORACIC VERTEBRAE and above the SACRAL VERTEBRAE. Vertebrae, Lumbar
D008279 Magnetic Resonance Imaging Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. Chemical Shift Imaging,MR Tomography,MRI Scans,MRI, Functional,Magnetic Resonance Image,Magnetic Resonance Imaging, Functional,Magnetization Transfer Contrast Imaging,NMR Imaging,NMR Tomography,Tomography, NMR,Tomography, Proton Spin,fMRI,Functional Magnetic Resonance Imaging,Imaging, Chemical Shift,Proton Spin Tomography,Spin Echo Imaging,Steady-State Free Precession MRI,Tomography, MR,Zeugmatography,Chemical Shift Imagings,Echo Imaging, Spin,Echo Imagings, Spin,Functional MRI,Functional MRIs,Image, Magnetic Resonance,Imaging, Magnetic Resonance,Imaging, NMR,Imaging, Spin Echo,Imagings, Chemical Shift,Imagings, Spin Echo,MRI Scan,MRIs, Functional,Magnetic Resonance Images,Resonance Image, Magnetic,Scan, MRI,Scans, MRI,Shift Imaging, Chemical,Shift Imagings, Chemical,Spin Echo Imagings,Steady State Free Precession MRI
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009852 Omentum A double-layered fold of peritoneum that attaches the STOMACH to other organs in the ABDOMINAL CAVITY. Omentums
D003646 Debridement The removal of foreign material and devitalized or contaminated tissue from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed. (Dorland, 27th ed) Debridements
D006406 Hematoma A collection of blood outside the BLOOD VESSELS. Hematoma can be localized in an organ, space, or tissue. Hematomas
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000785 Aneurysm, Infected Aneurysm due to growth of microorganisms in the arterial wall, or infection arising within preexisting arteriosclerotic aneurysms. Aneurysm, Bacterial,Aneurysm, Mycotic,Mycotic Aneurysm,Bacterial Aneurysm,Bacterial Aneurysms,Fungal Aneurysm,Infected Aneurysm,Aneurysm, Fungal,Aneurysms, Bacterial,Aneurysms, Fungal,Aneurysms, Infected,Aneurysms, Mycotic,Fungal Aneurysms,Infected Aneurysms,Mycotic Aneurysms
D000900 Anti-Bacterial Agents Substances that inhibit the growth or reproduction of BACTERIA. Anti-Bacterial Agent,Anti-Bacterial Compound,Anti-Mycobacterial Agent,Antibacterial Agent,Antibiotics,Antimycobacterial Agent,Bacteriocidal Agent,Bacteriocide,Anti-Bacterial Compounds,Anti-Mycobacterial Agents,Antibacterial Agents,Antibiotic,Antimycobacterial Agents,Bacteriocidal Agents,Bacteriocides,Agent, Anti-Bacterial,Agent, Anti-Mycobacterial,Agent, Antibacterial,Agent, Antimycobacterial,Agent, Bacteriocidal,Agents, Anti-Bacterial,Agents, Anti-Mycobacterial,Agents, Antibacterial,Agents, Antimycobacterial,Agents, Bacteriocidal,Anti Bacterial Agent,Anti Bacterial Agents,Anti Bacterial Compound,Anti Bacterial Compounds,Anti Mycobacterial Agent,Anti Mycobacterial Agents,Compound, Anti-Bacterial,Compounds, Anti-Bacterial

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