Abstract
A 59-year-old man was diagnosed with infective endocarditis (IE) complicated by severe aortic regurgitation and vegetation on the mitral valve. Although antibiotic administration and treatment of periodontal disease controlled the IE, he went into shock due to rupture of a mycotic aneurysm of the superior mesenteric artery. Transarterial embolization (TAE) maintained hemostasis, but ischemia of the ileum was suspected 90 minutes after TAE. Both the ischemic event and the risk of worsening infection in the aneurysm led us to perform emergency surgery. Laparotomy revealed an ischemic ileum with a massive hematoma in the mesentery. The coils placed during TAE aided detection of the aneurysm. Partial ilectomy, including the aneurysm, was performed under stable hemodynamic conditions. The patient successfully underwent a Bentall procedure and mitral valvuloplasty 92 days after the preceding surgery. TAE could be a useful technique for both hemostasis and subsequent surgery in cases of ruptured mycotic aneurysm. However, the fact that TAE can develop complications such as ischemic events must be taken into consideration.
