Figure 1. Coronal CT showing intussusception at the junction between the transverse colon and the hepatic flexure.
| Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access |
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Case Report
Volume 8, Number 2, February 2016, pages 168-174
Clostridium septicum Aortitis of the Infrarenal Abdominal Aorta
Figures
Tables
| First author | Year | Age | G | Process | Location | Neoplasm | Intervention | Outcome |
|---|---|---|---|---|---|---|---|---|
| Bridges [10] | 1981 | 68 | M | Aortic aneurysm | Infrarenal abdominal aorta | No | Extra-anatomical bypass (axillobifemoral bypass) and omental flap | Alive |
| Semel [11] | 1984 | 60 | F | Aortic aneurysm | Aortic arch- ascending aorta | Transverse colon cancer | Colon resection only | Died of cardiac tamponade 20 h after colon resection |
| Kaufman [12] | 1988 | 62 | M | - | Bilateral iliac arteries and femoral arteries | None | None | Died |
| Narula [13] | 1988 | 76 | M | - | Right popliteal artery | Cecal cancer | Resection of the aneurysm | Alive |
| Momont [14] | 1989 | 85 | F | Aortic aneurysm and dissection | Dissection of the ascending aorta and the arch | Cecal cancer | None | Died (sepsis?) |
| Asplund [15] | 1990 | 80 | M | - | Right iliac artery | Cecal cancer | Extra-anatomical bypass (femorofemoral bypass) | Alive (late death due to liver metastasis |
| Skipper [16] | 1990 | 70 | F | Aortitis | Suprarenal Abdominal aorta | No | Diagnosed at autopsy | Died during surgery |
| Brahan [17] | 1990 | 70 | F | Aortic aneurysm | Aortic arch- descending aorta | Ascending colon cancer | In situ graft replacement, resection of a fistulas between the aneurysm and the pulmonary artery | Alive |
| Hurley [18] | 1991 | 67 | M | Aortic aneurysm | Infrarenal abdominal aorta | Colonic polyps (rectum, splenic flexure and cecum) | Rt. axillobifemoral bypass followed by resection of the aneurysm, It. Ax-F bypass was performed because of infection of the rt. Ax-F bypass | Alive 9 months postoperatively |
| Christensen [19] | 1993 | 74 | F | Aortic aneurysm | Juxtarenal abdominal aorta | - | None | Died |
| Messa [20] | 1995 | 77 | M | Double aortic aneurysm | Distal descending aorta and infrarenal abdominal aorta (double aneurysms) | Sigmoid polyp cancer | Extra-anatomical bypass (axillobifemoral bypass) for the abdominal aorta, and in situ graft replacement of the descending aorta and omental flap | Alive |
| Murphy [21] | 1996 | 78 | M | Aortic aneurysm | Proximal descending aorta | Sigmoid polyps | In situ graft replacement, esophagectomy | Alive after 6 months |
| Sailors [22] | 1996 | 74 | F | Aortic aneurysm | Thoracoabdominal aorta | - | In situ replacement | Died presumably due to rupture of pseudoaneurysm in the distal anastomosis |
| Monsen [23] | 1997 | 81 | M | Aortic dissection | Dissection of the whole aorta (rupture at the infrarenal abdominal aorta | Cecal cancer | In situ graft repair | Died 6 h after surgery |
| Montoya [24] | 1997 | 78 | M | Aortic aneurysm | Descending aorta | Cecal cancer | None | Died 16 h after admission |
| Cohen [25] | 1998 | 77 | M | Aortic dissection and abscesses | Aortic root and Ascending aorta | Cecal adenocarcinoma | Rt. hemicolectomy | Died 23 days post-op |
| Johnson [26] | 1999 | 78 | M | Aortic aneurysm | Infrarenal abdominal aorta | - | None | Died 6 days after admission |
| Morrison [27] | 2001 | 71 | M | Aortic aneurysm | Thoracoabdominal aorta | Ascending colon cancer | In situ graft replacement | Alive |
| Al Bahrani [28] | 2001 | 63 | M | Aortic aneurysm | Infrarenal abdominal aorta | Ascending colon cancer | In situ graft replacement? | Alive? |
| Zenati [29] | 2002 | 87 | M | Aortic aneurysm and dissection | Abdominal aorta | Cecal adenocarcinoma | None | Died in the hospital at day 6 |
| Munshi [30] | 2002 | 78 | M | Aortic aneurysm | Infrarenal abdominal aorta | Cecal adenoma | None | Died 1 month after discharge |
| Takano [31] | 2003 | 69 | M | Aortic aneurysm | Infrarenal abdominal aorta | Ascending colon cancer | In situ graft replacement, rectus abdominal muscle flap | Alive |
| Liechti [32] | 2003 | 55 | M | Aortic aneurysm | Infrarenal aorta | Transverse colon adenocarcinoma | Transverse colectomy and exploration of the aorta without resection | Died 5 months after admission |
| Davies [33] | 2003 | 63 | M | Aortic aneurysm | Infrarenal | Unknown | Axillobifemoral bypass | Died 2 days post-op |
| Rucker [34] | 2004 | 77 | F | Aortic aneurysm | Infrarenal | Cecal adenocarcinoma | Axillobifemoral bypass and right colectomy | Died 42 days post-op |
| Rucker [34] | 2004 | 91 | F | Aortitis | Abdominal aorta | Ascending adenocarcinoma | Rt. hemicolectomy | Unknown |
| Evans [35] | 2004 | 91 | F | Aortitis | Abdominal | Transverse colon adenocarcinoma | Extended Rt. hemicolectomy | Died at 5 months |
| Creed [36] | 2004 | 77 | F | Aortitis then Aneurysm | Infrarenal Aneurysm | Colon cancer, poorly differentiated adenocarcinoma | Rt. hemicolectomy + axillobifemoral by pass + resection of infrarenal and two common Iliac arteries | Died on the 42nd POD 2/2 sepsis and MOF |
| Mohamed [37] | 2006 | 82 | M | Aortic aneurysm | Juxtarenal | Ascending adenocarcinoma | In situ graft, Rt. hemicolectomy | Alive |
| Asciutto [38] | 2007 | 71 | M | Aortitis then Aortic rupture | Juxtarenal Abdominal aneurysm | Colon carcinoma, ascending colon | Rt. hemicolectomy, then aortic replacement with dacron tube + IV Abx | Alive |
| Seder [9] | 2008 | 75 | M | Aneurysm | Infrarenal | Ascending adenocarcinoma | Rt. hemicolectomy and axillobifemoral bypass | Died at 4 months due to recurrent aortitis |
| Seder [9] | 2008 | 76 | F | Aortic aneurysm | Juxtarenal | Cecal adenocarcinoma | Axillobifemoral bypass and right hemicolectomy | Died at 94 day post-op |
| Yang [39] | 2009 | 22 | M | Aortitis then aortic dissection | Whole length of aorta | No | Nothing was done, diagnosed at autopsy | Died |
| Eplinius [40] | 2010 | 32 | M | Aortic dissection | Thoracic aorta | No | Diagnosed at autopsy | Died |
| Moseley [41] | 2010 | 82 | M | Aortitis | Infrarenal and Rt. common iliac artery | Cecal tubulovillous adenoma (high grade) | Suppressive IV Abx + Rt. hemicolectomy (Zosyn, Vanc and Levoflox) then IV cefepime and metronidazole (Pt. refused surgery) | Survival for 75 days after admission and died 2/2 ischemic heart dis. |
| Tsukioka [42] | 2013 | 74 | M | Aortic aneurysm C. difficle | Rt. common iliac artery | No | Excision of infrarenal and both common Iliac arteries | Alive |
| Lintin [43] | 2014 | 78 | F | Aortic aneurysm | Arch of aorta and thoracic aorta | Cecal adenocarcinoma and hepatic metastasis | Hybrid endovascular repair + laparoscopic Rt. hemicolec. + liver metastasis resection | Alive |
| Al Hadi [44] | 2014 | 63 | M | Aortic aneurysm | Aortic arch to mid thoracic aorta | Colorectal cancer | Rt. hemicolectomy and he did not make it to the vascular surg. | Died before the vascular surgery |
| Subramaniam [45] | 2014 | 16 | F | Aortic dissection | Ascending thoracic aorta | No | Diagnosed at autopsy | Rapid course of events, died before diagnosis |
| Shah [46] | 2015 | 78 | M | Aortic aneurysm | Infrarenal aorta | Colon cancer, hepatic flexure | Infrarenal resection and bypass grafting + IV Abx | Alive |
| Total number of patients with reported Clostridium aortitis | 40 |
| Males | 27 |
| Females | 13 |
| Average reported age | 70.5 years old |
| Aortic injury | |
| Aortic aneurysm alone | 25 (62.5%) |
| Aortic dissection | 7 (17.5%) |
| Aortitis alone | 4 (10.0%) |
| Aortic rupture | 1 (2.5%) |
| Unknown process | 3 (7.5%) |
| Interventions | |
| Surgical and medical Rx | 24 (60.0%) |
| Medical Rx only | 5 (12.5%) |
| None | 11 (27.5%) |
| Mortality rate following intervention | |
| Surgical and medical Rx | 2 out of 23 (8.6%) |
| Medical Rx only | 4 out of 5 (80%) |
| None | 12 out of 12 (100%) |
| Total reported survivors | 22 (55.0%) |
| Total reported mortalities | 17 (42.5%) |
| Unknown outcome | 1 (2.5%) |