Conservative management of a ruptured mycotic aneurysm

Mycotic aneurysms are a well-recognised complication of infective endocarditis. In contrast to many sequelae of endocarditis, they can present late in the course of the disease, despite adequate treatment. We discuss the case of an 82-year-old patient who was successfully treated for Enterococcus fa...

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Bibliographic Details
Published in:BMJ case reports 2013-05, Vol.2013, p.bcr2013008579
Main Authors: Lodge, Freya, Conway, Nerys, Waterfield, Nick
Format: Article
Language:English
Subjects:
80 Years
Abdomen
Aged, 80 and over
Aneurysm, Infected - etiology
Aneurysm, Infected - therapy
Aneurysm, Ruptured - etiology
Aneurysm, Ruptured - therapy
Aneurysms
Anti-Bacterial Agents - therapeutic use
Antibiotics
Embolization, Therapeutic
Endocarditis, Bacterial - complications
Enterococcus faecalis
Gram-Positive Bacterial Infections - complications
Gram-Positive Bacterial Infections - therapy
Heart failure
Humans
Magnetic Resonance Angiography
Male
Medical imaging
Mesenteric Artery, Superior
Mortality
Pain
Patients
Reminder of Important Clinical Lesson
Tomography, X-Ray Computed
Ultrasonic imaging
United Kingdom
Urine
Veins & arteries
White
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Summary:Mycotic aneurysms are a well-recognised complication of infective endocarditis. In contrast to many sequelae of endocarditis, they can present late in the course of the disease, despite adequate treatment. We discuss the case of an 82-year-old patient who was successfully treated for Enterococcus faecalis endocarditis, but presented late with a hypotensive collapse. CT imaging demonstrated a ruptured mycotic aneurysm. He underwent laparotomy, but the decision was made to treat conservatively to protect the vascular supply to the bowel. The patient subsequently made a full recovery.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2013-008579