Infected Abdominal Aortic Aneurysm Associated with Horseshoe Kidney: A Case Report

Abstract

We report a rare case of infected pseudoaneurysm associated with horseshoe kidney post graft replacement of the abdominal aorta. A 78-year-old man with chronic kidney disease and a surgical history of Y-shaped graft replacement in the abdominal aorta 25 years earlier, was hospitalized with the chief complaints of persistent fever and appetite loss. Computed tomography showed a 60 mm-sized pseudoaneurysm around the proximal anastomosis site accompanied by peri-prosthetic high fatty tissue density and a horseshoe kidney overlying the abdominal aorta. An accessory renal artery supplying the right kidney originated from the right leg of the previous Y-graft. Infectious pseudoaneurysm was strongly suspected because intensive medical treatment was not effective, and positron emission tomography-computed tomography demonstrated high fluorodeoxyglucose accumulation around the proximal anastomosis site. Open surgery was thus performed through a re-laparotomy approach. After obtaining a good surgical view after transection of the horseshoe kidney isthmus using the Liga-Sure Vessel sealing system, radical resection of the suspected infectious tissue and I-graft replacement with omental flap coverage were safely performed. The previous reattached accessory artery was left untouched because infection seemed to be out of range. Streptococcus dysgalactiae/canis was detected via postoperative culture test from the resected felt strip that was used in the previous vascular surgery. The postoperative course was uneventful without recurrence of infection or worsening of renal function; the patient was discharged on postoperative day 34 after completion of a sensitive antibiotics protocol.