|
Back to 2016 Annual Symposium ePosters
A Rare Case of Clostridium Septicum Aortitis with Colon Adenocarcinoma treated with Excision and Aortic Homograft
Niti Shahi, BS, Mariano Arosemena, MD, Jeontaik Kwon, MD, Andrew Brown, MD, Babak Abai, MD, FACS, Paul J. DiMuzio, MD, FACS, Dawn M. Salvatore, MD, FACS.
Thomas Jefferson University Hospital, PHILADELPHIA, PA, USA.
ABSTRACT
OBJECTIVE
Clostridium septicum aortitis is a rare highly morbid condition typically accompanied by malignancy. We present the first reported case of C. septicum aortitis with associated colon adenocarcinoma successfully treated with excision of the infected aorta and replacement with an aortic homograft, in addition to a literature review.
METHODS
A 66 year-old man presented with a three day history of abdominal pain, fevers to 102.3, chills, and bloody bowel movements. CTA revealed peri-aortic wall gas throughout the infrarenal aorta and colonic wall thickening, suggesting a mass.
Laboratory studies showed elevated WBC of 19.5, and blood cultures were positive for C. septicum. He was placed on broad spectrum antibiotics. Colonoscopy showed a cecal adenocarcinoma with biopsy. He remained clinically stable with persistent fevers and abdominal pain.
Patient underwent transabdominal excision of the infected infrarenal aorta with aortobi-iliac reconstruction utilizing a cryopreserved homograft and left renal artery re-implantation along with right hemicolectomy and Ab-thera wound vacuum placement. Two days later, an end ileostomy was created, and the abdominal wall was closed. Intraoperative vascular tissue cultures grew C. septicum, with antibiotics converted to IV unasyn.
Postoperative course was uneventful with the exception of acute renal failure (peak Cr 6.2 with excellent UOP, without need for dialysis). By POD 7, Cr dropped to 2.2 and subsequently down to 1.5. He remained afebrile with normalized WBC and clearing of bacteremia.
Literature review showed 22 cases of Aortic C. septicum infection with colon adenocarcinoma.
RESULTS
Surgical management is essential in the treatment of C. septicum aortitis; all mortalities in the case analysis occurred in patients treated only medically. Among the 22 patients, 14 underwent surgery for aortitis: ax-bifemoral bypass in 36.4% (8/22), and aortic replacement in 31.8% (7/22). In the aortic graft patients, 85.7% (6/7) received tube grafts: 42.9% (3/7) Dacron and 28.6% (2/7) PTFE. Our case is the first managed with homograft vascular reconstruction. The most common reported complication in aortic graft patients was acute kidney injury in 42.7% (3/7), with 28.6% (2/7) requiring hemodialysis. .
CONCLUSIONS
Our early results show that C. septicum aortitis can be successfully managed with excision and aorto-iliac reconstruction utilizing an arterial homograft.
Back to 2016 Annual Symposium ePosters
|
