Abstract
A case of infected ruptured aneurysm of the superior mesenteric artery (SMA) is described. A 46-year-old man was referred to our hospital because of infective endocarditis (IE) involving the mitral valve. Because treatment with antibiotics was infective, and despite being in the active phase of infection associated with brain abscess, mitral valve replacement was performed successfully. One month later, the patient was found unconscious with massive hematemesis and melena. An abdominal CT scan showed a ruptured aneurysm of the SMA penetrating into the terminal duodenum. Direct suture of the SMA and combined resection of the aneurysm and the terminal duodenum seved the patient. However, recurrent bleeding from the involved artery obliged us to do additional repeat laparotomies and a transarterial embolization of the SMA. The clinical course and pathological findings which showed and inflammatory change of the aneurysm wall without atherosclerosis, suggested that the aneurysm was caused by vegetation derived from IE. Although ruptured aneurysm of the SMA associated with infection is rarely seen cafeful follow-up is necessary for the management of patients with IE.
