Mycotic superior mesenteric aneurysm

Abstract

A 36-year-old man with a history of aortic valve replacement secondary to streptococcal endocarditis 8 years before admission presented with unexplained severe epigastric pain. After an extensive work-up, a 5-cm superior mesenteric artery (SMA) aneurysm was identified by computer tomography (CT). Three-dimensional CT reconstruction (Cover) and selective arteriography (A) demonstrated that the aneurysm arose from the main trunk of the SMA beyond the first segmental branches. The aneurysm was thought to be mycotic due to the patient’s history and the absence of any other vascular disease. The densely scarred SMA aneurysm was exposed through the transverse mesocolon (B) (note that a vessel loop surrounds the proximal SMA at the base of the mesocolon), the aneurysm resected, and a saphenous vein interposition graft performed (C). The patient’s recovery was unremarkable, and he was discharged home on postoperative day 5. As anticipated, cultures of the aneurysm were negative due to long-term (6 weeks) postoperative antibiotics 8 years ago.