Embolization of a left uterine artery mycotic aneurysm after a neglected, perforated appendicitis before delivery

Abstract

Key Clinical MessageWe report a case of a successful embolization of a mycotic aneurysm of the left uterine artery in the puerperium after a neglected perforated appendicitis. A mycotic aneurysm, meaning an infection of the vessel wall which leads to an aneurysmatic dilatation of the vessel, is potentially life threatening if rupture occurs.

Case report of multiple mesenteric mycotic aneurysms after perforated appendicitis

“…Mycotic aneurysms are well-known complications of septic episodes and infectious diseases and are associated with a significant morbidity and mortality, especially in case of severe sepsis or arterial rupture [ 1 ]. However, purulent peritonitis due to a perforated appendicitis as a cause of mycotic aneurysm formation is rare and only described in a few cases [ [2] , [3] , [4] , [5] , [6] , [7] ]. Arteries can be affected by bacterial or fungal organisms from a neighbouring source of infection, causing aneurysmatic dilatation and possibly rupture of the vessel wall.…”

“…However, mycotic aneurysm formation caused by a perforated appendicitis is very rare, especially mycotic aneurysms of the mesenteric arteries. In previous literature, only a few comparable cases have been described reporting the formation of mycotic aneurysms of the abdominal aorta, iliac arteries and uterine arteries after perforated appendicitis [ [2] , [3] , [4] , [5] , [6] , [7] ].…”

Acute intraabdominal hemorrhage from an aneurysm on uterine artery

“…2 Bacterial or fungal inflammation of the vessel wall can lead to dilatation of the vessel and formation of aneurysm. 3 Pseudoaneurysm that doesn't have three arterial layers is rather more often reported as causes of rupture events from uterine artery than true aneurysm. Pseudoaneurysms are often related to surgical injury to uterus, cesarean section, curettage, vaginal delivery, or conization.…”

A hybrid approach to appendicitis with right external iliac artery pseudo aneurysm: A case report

“…While appendectomy is the only therapeutic option in uncomplicated acute appendicitis, a non-operative approach is generally preferred in cases complicated by abscess formation [2] . Vascular complications arising from appendicitis are extremely rare [3] , [4] , [5] , [6] , [7] , [8] . Infected pseudoaneurysms are also rare and generally are associated with a poor prognosis due to the advanced age and comorbidities of these patients [9] .…”