A Case of Tuberculous Abdominal Aortic Aneurysm Diagnosed after the Endovascular Aortic Repair and Subsequently Associated with Aorto-duodenal Fistula

Abstract

Infected aortic aneurysms are rare, accounting for 3% of all aortic aneurysms, but tuberculous aortic aneurysms are even rarer. Here in, we report a case of tuberculous abdominal aortic aneurysm (AAA), which was diagnosed after endovascular aneurysm repair, and subsequently developed aorto-duodenal fistula (ADF) after anti-tuberculosis therapy. The patient was an 84-years-old male. He had a history of Bacillus Calmette-Guérin (BCG) intravesical infusion therapy for bladder cancer. EVAR was performed for a rapidly enlarging saccular AAA. Nine months after the surgery, the aneurysm enlarged without clear etiology. Diagnosis of type V endoleak was made, and EVAR was performed once again. However, one month after the procedure, fever and aneurysm enlargement was observed. Mycobacterium bovis was detected in CT-guided biopsy culture, leading to the diagnosis of a tuberculous AAA. After starting on multiple anti-tuberculosis drugs, the inflammation subsided, and the aneurysm diameter stabilized. Seven months later, the patient developed fever again, and CT scan showed a large amount of free air in the aneurysm sac, suggesting presence of ADF. Laparotomy confirmed presence of ADF, and fistula closure, partial removal of the stent graft, and omentum coverage was performed. The patient had a good postoperative course and has been free of recurrence for more than a year. The possibility of tuberculous AAA should always be kept in mind for patients with a history of intravesical BCG therapy. Furthermore, ADF should be considered when inflammation rises during anti-tuberculosis therapy for patients with tuberculous AAA.