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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Infection of the aorta usually results from septic embolization to the vasa vasorum, hematogenous seeding of an existing aneurysm, or extension from a contiguous site of infection. The diagnosis should be considered in patients, often men over the age of 50 years with atherosclerosis, who present with fever, abdominal pain, palpable abdominal mass, and leukocytosis, with or without positive blood cultures. In the pre-antibiotic area, infectious aortitis was largely a complication of infective endocarditis, and was usually caused by group A streptococci, Streptococcus pneumoniae, or Haemophilus influenzae. Now a diverse array of bacteria and fungi has been associated, most commonly Salmonella species, which comprise nearly one third of the abdominal aortic infections and Staphylococcus aureus. Computed tomography is the most useful imaging modality. Medical treatment alone carries a high mortality, whereas the mortality with surgery combined with antimicrobial treatment is lower. Empiric antibiotics effective against S. aureus and gram-negative rods, such as Salmonella, should be initiated in cases identified before microbiologic diagnosis. Surgical debridement and revascularization should be completed early because delay may lead to aneurysm rupture, which increases mortality. The intent of surgery is to 1) control hemorrhage, if the aneurysm has ruptured; 2) confirm the diagnosis; 3) control sepsis; and 4) reconstruct the arterial vasculature. The patient should remain on parenteral or oral antibiotics for at least 6 weeks, perhaps longer, to assure full eradication of the pathogen and prevent recurrent infection. Close medical follow-up is indicated and includes serial blood cultures and computed tomography scans.
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PMID:Infectious Aortitis. 1593 17

Prompt diagnosis of aortoenteric fistulas is imperative for patient survival. The clinical signs of aortoenteric fistula include hematemesis, melena, sepsis, and abdominal pain, but the condition also may be clinically occult. Because clinical signs may not be present or may not be sufficiently specific, imaging is most often necessary to achieve an accurate diagnosis. Although no single imaging modality demonstrates the condition with sufficient sensitivity and specificity, computed tomography (CT), owing to its widespread availability and high efficiency, has become the imaging modality of choice for evaluations in the emergency setting. CT has widely variable sensitivity (40%-90%) and specificity (33%-100%) for the diagnosis of aortoenteric fistulas. To use this modality effectively for the initial diagnostic examination, radiologists must be familiar with the spectrum of CT appearances. Mimics of aortoenteric fistulas include retroperitoneal fibrosis, infected aortic aneurysm, infectious aortitis, and perigraft infection without fistulization. Differentiation is aided by the observation of ectopic gas, loss of the normal fat plane, extravasation of aortic contrast material into the enteric lumen, or leakage of enteric contrast material into the paraprosthetic space; these features are highly suggestive of aortoenteric fistula in a patient with bleeding in the gastrointestinal tract.
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PMID:Aortoenteric fistulas: CT features and potential mimics. 1916 45

Primary aortoenteric fistula is most commonly caused from erosion of the bowel wall by an abdominal aortic aneurysm. Septic aortitis with pseudoaneurysm formation and finally erosion into the duodenum represents a rare cause that has been described in very few patients in the literature. We present a rare clinical case of Salmonella aortitis and associated infrarenal aortic pseudoaneurysm that evolved into an aortoduodenal fistula. A 51-year-old man was admitted in our hospital with symptoms and signs of sepsis caused by Salmonella bacteremia. Imaging studies revealed an infrarenal aortic pseudoaneurysm. The patient presented hemodynamic instability, and during emergency laparotomy a fistula was found between the third portion of the duodenum and a false aneurysm arising from a nonaneurysmal grossly infected aorta. The affected aortic segment was excised and the intestinal defect was repaired. The aortic stumps were sutured and an axillobifemoral bypass was performed. The patient had an uncomplicated postoperative course.
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PMID:Primary aortoenteric fistula due to septic aortitis. 2047 86

We report a case of a 75-year-old man who had been complaining of fever and pelvic pain for 3 weeks. First angio-computed tomography (CT) characteristics and blood culture led to suspicion of a pneumococcal-infected aortic aneurysm, which however was not confirmed by the surgeon. The abdominal infectious aortitis caused by Streptococcus pneumoniae was affirmed by a second angio-CT performed 7 days later. Without further delay, the patient underwent surgery for resection of mycotic aneurysm and in situ reconstruction with aortobiiliac homograft, in association with antibiotics. He died 10 days after the surgery as a result of severe sepsis in a polyvalent intensive care unit. This case report highlights the severity of this pathology. We reviewed the relevant literature related to Streptococcal pneumoniae mycotic aneurysm located in the abdominal aorta, including 29 more cases. Various microorganisms have already been associated with mycotic aneurysms, including S pneumoniae. Infectious aortitis remains a rare disease. It is extremely important to establish an early diagnosis but it may be delayed because clinical manifestations are usually nonspecific. However, if left untreated it is always lethal. Antibiotic in combination with complete surgical excision of the infected aorta is the treatment of reference. This therapeutic association dramatically improved patient survival.
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PMID:Abdominal infectious aortitis caused by Streptococcus pneumoniae: a case report and literature review. 2092 47

Arterio-enteric fistula is a rare, but potentially deadly cause of gastrointestinal bleeding. The disease occurs in two forms: primary as a result of atherosclerotic aortic aneurysm, aortitis, trauma, radiation, tumor invasion or penetrating ulcer, and secondary as a consequence of surgical aortal reconstruction. The clinical manifestation is mostly gastrointestinal bleeding, rarely back pain, fever and sepsis. Computed tomography with contrast medium is the most suitable diagnostic test, however, the diagnosis frequently requires explorative laparotomy. A case is presented of secondary arterio-enteric fistula, found two years after surgical treatment of chronic pancreatitis with pseudocystojejunostomy, which clinically manifested with gastrointestinal bleeding. Although there was strong suspicion of arterio-enteric fistula, the diagnosis was not verified by routine workup, but only on explorative laparotomy.
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PMID:Secondary arterio-enteric fistula: case report and review of the literature. 2292 6

Infection of an abdominal aortic prosthesis with an enteroprosthetic fistula is a very serious, life-threatening complication, leading sometimes to severe functional consequences, the most serious being amputation. Since the symptoms, if there are any, are often rather non-specific, diagnosis is frequently difficult and has always to be based on a whole series of justifications. Early diagnosis is essential and this fistula should be the first possibility considered in a patient with an abdominal aortic prosthesis who is presenting rectorrhagia or melaena (even if only to a slight degree), sepsis and/or abdominal pain. Although rare, the clinical existence of hypertrophic osteoarthropathy may assist diagnosis. A CT scan is the examination of choice, the criteria providing evidence of a fistula being the presence of gaseous images in a periprosthetic fluid collection, thickening and/or retraction of the intestinal walls in contact, the existence of a false aneurysm, and finally, very rarely, extravasation of contrast agent into the intestinal lumen. The differential diagnoses that may mimic a fistula need to be well known, and can include retroperitoneal fibrosis, an infectious aneurysm, inflammatory or infectious aortitis, and above all, a 'simple' prosthesis infection without fistulisation.
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PMID:Aorto-enteric fistulas: a physiopathological approach and computed tomography diagnosis. 2309 21

In patients without history of vascular surgery, infectious aortitis is a very uncommon, life-threatening condition with nonspecific clinical manifestations, which exposes the patient to uncontrolled sepsis and to the risk of retroperitoneal rupture. State-of-the-art cross-sectional imaging with contrast-enhanced multidetector computed tomography and magnetic resonance imaging allows confident diagnosis and characterization of unsuspected aortitis in septic patients at an early stage before the development of aneurysmal dilatation. The asymmetric distribution of periaortic inflammatory tissue is helpful for the differentiation of this exceptional disorder from other periaortic abnormalities such as retroperitoneal fibrosis or lymphoma.
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PMID:Early non-aneurysmal infectious aortitis: Cross-sectional imaging diagnosis. 2372 29

The development of an abdominal aortic aneurysm secondary to infectious aortitis following solid organ transplantation is a rare event that in the absence of surgical intervention, can lead to uncontrolled sepsis, catastrophic hemorrhage and death. Arterial allografts have been a viable surgical option for the past 30 years, although operative modalities have undergone a paradigm shift in recent years. We describe the first case in the literature of a liver transplant recipient who developed an infrarenal aortic aneurysm secondary to Salmonella bacteraemia, which was treated successfully with aortic allograft transplantation.
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PMID:Infectious aortitis in a liver transplant recipient. 2391 47

Infectious thoracic aortitis is a rare disease, especially since the incidence of syphilis and tuberculosis has dropped in western countries. However, the risk to develop an infectious aortitis and subsequent mycotic aneurysm formation is still present, particularly in case of associated endocarditis, sepsis, and in immunosuppressive disorders. Moreover, the number of surgical and endovascular thoracic aortic repairs is continuously increasing, and infective graft complications are observed more frequently. Several etiopathogenetic factors may play a role in thoracic aortic and prosthetic infections, including hematogenous seeding, local bacterial translocation, and iatrogenous contamination. Also, fistulization of the esophagus or the bronchial tree is commonly associated with these diseases, and it represents a critical event requiring a multidisciplinary management. Knowledge on underlying micro-organisms, antibiotic efficacy, risk factors, and prevention strategies has a key role in the management of this spectrum of infectious diseases involving the thoracic aorta. When the diagnosis of a mycotic aneurysm or a prosthetic graft infection is established, treatment is demanding, often including a number of surgical options. Patients are usually severely compromised by sepsis, and in most cases they are considered unfit for surgery for general clinical conditions or local concerns. Thus, results of different therapeutic strategies for infectious diseases of the thoracic aorta are still burdened with very high morbidity and mortality. In this manuscript, we review the literature regarding the main issues related to thoracic infectious aortitis and aortic graft infections, and we report our personal series of patients surgically treated at our institution for these conditions from 1993 to 2014.
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PMID:Strategies to treat thoracic aortitis and infected aortic grafts. 2560 72

The primary goals of surgery for mycotic thoracic aortic aneurysms include control of sepsis, radical debridement of infected tissue, anatomic or extra-anatomic aortic reconstruction, and prevention of recurrent infection. Patients with Salmonella aortitis are a challenging subgroup of patients with aggressive infection and very poor prognosis, because bacterial eradication is difficult and risk of recurrent infection is high. We report the successful surgical management of a patient who presented with a ruptured Salmonella aortic arch aneurysm with extensive debridement and near circumferential autologous pericardial patch reconstruction of the aortic arch.
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PMID:Autologous Pericardial Reconstruction of Ruptured Salmonella Mycotic Aortic Arch Aneurysm. 2652 28


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