Elsevier

Annals of Vascular Surgery

Volume 28, Issue 8, November 2014, Pages 1933.e7-1933.e14
Annals of Vascular Surgery

Case Report
Mycotic Abdominal Aortic Aneurysm Caused by Campylobacter fetus: A Case Report and Literature Review

https://doi.org/10.1016/j.avsg.2014.06.072Get rights and content

Campylobacter spp. usually cause gastrointestinal infections, but among them, Campylobacter fetus is a well-known organism causing mycotic abdominal aortic aneurysm (MAAA), which requires proper surgical intervention and antibiotic therapy. We report a 65-year-old man who was successfully treated by an in situ operation using a rifampicin (RFP)–bonded J-Graft for C. fetus–induced MAAA. We performed a review of the English literature on MAAA caused by C. fetus and summarized the results of the cases (28 cases). All but 2 of the patients (92.9%) were men. Blood culture and arterial wall culture were positive in 63% and 73.1% of the cases, respectively. Aneurysm rupture was seen in half of the patients, and approximately half of those patients died. Among the 18 patients who underwent in situ graft replacement, only 1 patient (5.6%) died after surgery. Antibiotic therapy was performed for more than 1 month in most cases, and overall mortality rate was 25.9% (7 of 27 cases, 3 deaths before the operation and 4 deaths after surgery). Although extra-anatomic bypass has been conventionally performed after complete resection of an MAAA, the utility of in situ surgery has generally been recognized. Our review suggests that the in situ operation can be a choice also in cases of C. fetus–associated MAAA. Furthermore, our case suggested the clinical utility of a newly manufactured prosthetic graft, J-Graft, for such surgical treatment.

Section snippets

Case Report

A 65-year-old man without any past medical history presented with a 1-week history of lumbar pain. He had an episode of diarrhea 2 weeks previously, but the etiology was unknown. There was no history of drinking raw milk or consuming uncooked meat. A urinary examination showed hematuria, and he returned home with the diagnosis of urolithiasis. The next day, he consulted an urologist and was again diagnosed as having urolithiasis although a urinary tract stone was not apparent in plain computed

Discussion

C. fetus is a motile gram-negative rod with a spindle form, which is carried by livestock such as cattle and sheep. While C. jejuni and C. coli cause gastrointestinal symptoms after ingestion, C. fetus frequently causes bacteremia without any digestive manifestations. Actually, unlike C. jejuni or C. coli, most cases of C. fetus infection have been diagnosed from positive results of blood culture; according to a previous summary of 178 Campylobacter bacteremia patients, C. fetus was the most

References (44)

  • P.R. Taylor et al.

    Campylobacter fetus infection in human subjects: association with raw milk

    Am J Med

    (1979)
  • M.O. Perry

    Infected aortic aneurysms

    J Vasc Surg

    (1985)
  • E.J. Rutherford et al.

    Abdominal aortic aneurysm infected with Campylobacter fetus subspecies fetus

    J Vasc Surg

    (1989)
  • J. Brossier et al.

    New bacteriological patterns in primary infected aorto-iliac aneurysms: a single-centre experience

    Eur J Vasc Endovasc Surg

    (2010)
  • F.Y. Chan et al.

    In situ prosthetic graft replacement for mycotic aneurysm of the aorta

    Ann Thorac Surg

    (1989)
  • C.H. Lee et al.

    In situ versus extra-anatomic reconstruction for primary infected infrarenal abdominal aortic aneurysms

    J Vasc Surg

    (2011)
  • N. Uchida et al.

    In situ replacement for mycotic aneurysms on the thoracic and abdominal aorta using rifampicin-bonded grafting and omental pedicle grafting

    Ann Thorac Surg

    (2012)
  • P.D. Hayes et al.

    In situ replacement of infected aortic grafts with rifampicin-bonded prostheses: the Leicester experience (1992 to 1998)

    J Vasc Surg

    (1999)
  • D.F. Bandyk et al.

    Use of rifampin-soaked gelatin-sealed polyester grafts for in situ treatment of primary aortic and vascular prosthetic infections

    J Surg Res

    (2001)
  • A.K. Gupta et al.

    In situ repair of mycotic abdominal aortic aneurysms with rifampin-bonded gelatin-impregnated Dacron grafts: a preliminary case report

    J Vasc Surg

    (1996)
  • C.D. Kan et al.

    The efficacy of aortic stent grafts in the management of mycotic abdominal aortic aneurysm-institute case management with systemic literature comparison

    Ann Vasc Surg

    (2010)
  • M. Alonso et al.

    Infected abdominal aortic aneurysm: in situ replacement with cryopreserved arterial homograft

    J Cardiovasc Surg (Torino)

    (1997)
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    Conflicts of Interest: The authors state that there are no conflicts of interests to declare.

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