Clostridium septicum aortitis: Report of two cases and review of the literature

• Published in: Journal of vascular surgery 2009-05, Vol.49 (5), p.1304-1309
• Main Authors: Seder, Christopher W., MD, Kramer, Michael, BS, Long, Graham, MD, Uzieblo, Maciej R., MD, Shanley, Charles J., MD, Bove, Paul, MD
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - complications; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Aged; Aged, 80 and over; Aneurysm, Infected - diagnostic imaging; Aneurysm, Infected - microbiology; Aneurysm, Infected - therapy; Anti-Bacterial Agents - therapeutic use; Aortic Aneurysm - diagnostic imaging; Aortic Aneurysm - microbiology; Aortic Aneurysm - therapy; Aortitis - diagnostic imaging; Aortitis - microbiology; Aortitis - therapy; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation; Cardiology. Vascular system; Clostridium Infections - complications; Clostridium Infections - diagnostic imaging; Clostridium Infections - microbiology; Clostridium Infections - therapy; Clostridium septicum - isolation & purification; Colonic Neoplasms - complications; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Debridement; Digestive System Surgical Procedures; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Fatal Outcome; Female; Humans; Male; Medical sciences; Middle Aged; Recurrence; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2008.11.058

Clostridium septicum aortitis is a rare infection that has a strong association with occult colonic malignancy. To our knowledge, we report the 25th and 26th cases of C septicum aortitis in the English literature and make recommendations for its management. The first patient was a 75-year-old man who presented with abdominal pain. Computed tomography showed the presence of periaortic gas. He underwent aortic débridement and extra-anatomic bypass after blood cultures revealed C septicum . Four months after the initial presentation, he was readmitted with lethargy, found to have recurrent periaortic gas, and died. The second patient was a 76-year-old woman who presented with a 5-cm abdominal aortic aneurysm with surrounding retroperitoneal gas. She underwent emergency aortic ligation and retroperitoneal débridement. Her blood and intraoperative tissue cultures also grew C septicum . She had a prolonged postoperative course and ultimately died on hospital day 94. Both patients were found to have concurrent colon adenocarcinomas. C septicum aortitis is a lethal disease that necessitates prompt surgical intervention and appropriate antibiotic therapy. The strong association of C septicum with occult malignancy should prompt the astute clinician to undertake an exhaustive search for a neoplastic process.