A case of endovascular aortic repair for rupture of infected abdominal aortic aneurysm concomitant with perforated appendicitis

Abstract

A 66-year-old gentleman, who had been dependent on hemodialysis for three years, was transferred to our hospital for the treatment of severe systemic inflammation accompanied by pyrexia and malaise. Plain computed tomography (CT) suggested an inflammatory abdominal aortic aneurysm (AAA), and contrast-enhanced CT revealed an occurrence of perforated appendicitis next day. Intravenous antibiotic therapy was initiated by meropenem and vancomycin, and then, metronidazole and cefazolin were added in consideration of complicated intraabdominal infection associated with methicillin-susceptible Staphylococcus aureus detected in the blood culture. Although systemic inflammation was gradually attenuated, a rupture of AAA was occurred 25 days after hospitalization and an endovascular aortic repair (EVAR) was performed on an emergency basis. Postoperative antibiotic therapy achieved stable clinical course without relapses of systemic inflammation, and the patient was discharged 76 days after EVAR. Intensive antibiotic therapy averted critical events without the use of intraoperative debridement in the present case, which may suggest that EVAR should be an option of less invasive therapies for infected AAA.