Implications of Clostridium septicum in Vascular Surgery: A Case Report and Outcomes Literature Review

Alimi, Yewande; Sosin, Michael; Borsinger, Tracy M.; Garrett, J. R.; Salameh, J.R.; Espinel, Camilo

doi:10.1016/j.avsg.2017.03.178

Cited by 17 publications

(15 citation statements)

References 39 publications

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“…It is postulated that the organism grows in the hypoxic necrotic milieu of the tumor and induces necrosis via α‐toxin, thereby leading to mucosal ulceration and hematogenous spread . Hematogenous seeding of the aorta specifically leads to the development of mycotic aneurysm within a week, which is always lethal in the absence of surgical intervention . The 6‐month mortality rate among the patients who underwent surgical intervention ranged between 44% with in situ grafts vs 66.7% with axillobifemoral bypass .…”

Section: Discussionmentioning

confidence: 99%

“…Hematogenous seeding of the aorta specifically leads to the development of mycotic aneurysm within a week, which is always lethal in the absence of surgical intervention . The 6‐month mortality rate among the patients who underwent surgical intervention ranged between 44% with in situ grafts vs 66.7% with axillobifemoral bypass . This difference in outcome is related to the complications frequently seen with extra‐anatomic revascularization of infected aortic aneurysms (as seen in axillobifemoral bypass), aortic stump blowout (20%), lower limb amputation due to bypass failure (20%‐29%), and reinfection (20%) .…”

Section: Discussionmentioning

confidence: 99%

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Clostridium septicum aortitis: A kiss of the devil

et al. 2019

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Background: Clostridium septicum aortitis is a lethal infection. C. septicum has a strong association with an underlying malignancy, most commonly in the colon.Aim: Early identification methods and management strategies of C. Septicum infection. Materials and Methods:We present a 64-year-old man with aortic aneurysm and C.septicum bacteremia with unknown malignancy who passed away on the fourth day of hospitalization despite emergent endovascular intervention. Computed tomography showed periaortic gas which is the hallmark of infection.Discussion: This case report highlights the need of prompt surgical treatment and its different modalities along with the early use of appropriate antibiotics due to the rapid spread of infection associated with high fatality. The authors also discuss the association of C. septicum aortitis with underlying occult malignancies.Conclusion: Delay in identification and treatment of C. Septicum is associated with very high mortality rates. K E Y W O R D S aortitis, bacteremia, Clostridium septicum, malignancy, periaortic air

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clostridium septicum aortitis: A kiss of the devil

et al. 2019

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“…However, thoracic aortitis causing Stanford type A aortic dissection, as in our case, is extremely rare. Since our patient's blood pressure was within normal ranges, the reason of acute dissection in this case was not hypertension but tissue fragility due to C. septicum aortitis, as in the literature review [6]. Among 15 patients with C. septicum-infected ascending aorta/arch aortitis, as in our case, 5 died with diagnosis of aortitis at autopsy, 3 underwent colon surgery but not aortic surgery (all died), 3 underwent vascular surgery but not cancer surgery (1 died and 2 survived), and 4 underwent aortic surgery followed by colon surgery, as in our case, all of whom survived.…”

Section: Discussionmentioning

confidence: 60%

“…There were several reports of C. septicum-infected aortitis, associated with high mortality up to 80% [4][5][6]. According to them, the sites of aortitis included ascending/ arch (n = 15), descending (n = 6), thoracoabdominal (n = 6), and abdominal (n = 20).…”

Section: Discussionmentioning

confidence: 99%

“…Among 15 patients with C. septicum-infected ascending aorta/arch aortitis, as in our case, 5 died with diagnosis of aortitis at autopsy, 3 underwent colon surgery but not aortic surgery (all died), 3 underwent vascular surgery but not cancer surgery (1 died and 2 survived), and 4 underwent aortic surgery followed by colon surgery, as in our case, all of whom survived. All survived patients underwent in-situ grafting, neither axillobifemoral bypass nor endovascular repair [4][5][6]. No patients underwent cancer surgery followed by aortic surgery.…”

Section: Discussionmentioning

confidence: 99%

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Clostridium septicum-infected Stanford type A acute aortic dissection: a case report

et al. 2020

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Background: Thoracic aortitis caused by Clostridium septicum is a rare infection with a strong association with malignancy and high mortality rate when left untreated. We report a case of surgical treatment for Stanford type A acute aortic dissection in a patient with C. septicum sepsis and thoracic aortitis. Case presentation: A 63-year-old hypertensive man with rheumatoid arthritis presented with general malaise and diagnosed with C. septicum-infected aortitis with sepsis. On the 5th day of hospitalization, Stanford type A acute aortic dissection developed with severe aortic regurgitation. The patient underwent emergent surgical treatment successfully with excision of the infected ascending aorta and aortic root followed by replacement using a composite graft, followed by diagnosis of sigmoid colon cancer 7 months after aortic surgery. He was scheduled to undergo elective colon surgery. Conclusions: C. septicum aortitis can progress quickly, causing aneurysm or dissection. Therefore, in a patient with C. septicum aortitis, prompt surgical in situ graft replacement should be performed to debride the infected vascular lesions. Further investigations for gastrointestinal and hematological malignancies as a source of C. septicum should be also conducted.

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A rare case of mycotic aortic aneurysm with Clostridium perfringens culture

Tadayon,

Shahsavari,

Yahya

et al. 2023

Clinical Case Reports

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Key Clinical MessageAs only early diagnosis, prompt surgical intervention, and appropriate antibiotic therapy can decrease clostridial MAA mortality rate; keeping in mind a broad differential diagnosis in a patient with sepsis and unusual vascular symptoms is important.AbstractMycotic aortic aneurysm (MAA) is an infrequent but very consequential condition characterized by the pathological disruption of the aorta due to infection. Clostridium perfringens is a bacterium that falls under the taxonomic classification of the genus Clostridium. Although mycotic aneurysm is often not commonly linked with this infection, there are instances when it may function as a causative agent for MAA. Timely diagnosis and thorough therapeutic techniques, including surgical intervention and quick administration of appropriate antibiotics, can potentially reduce the mortality rate associated with clostridial MAA. In this study, we presented a clinical report detailing the diagnosis of a mycotic aneurysm caused by C. perfringens in the thoracic aorta in a 66‐year‐old male patient with a history of diabetes mellitus and a recent prostate biopsy. Furthermore, we discussed the surgical approach and overall management strategy to address this case.

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Implications of Clostridium septicum in Vascular Surgery: A Case Report and Outcomes Literature Review

Cited by 17 publications

References 39 publications

Clostridium septicum aortitis: A kiss of the devil

Clostridium septicum aortitis: A kiss of the devil

Clostridium septicum-infected Stanford type A acute aortic dissection: a case report

A rare case of mycotic aortic aneurysm with Clostridium perfringens culture

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