Successful Extra-anatomical Management of a Salmonella-Associated Mycotic Pseudoaneurysm of the Left Common Iliac Artery

TL;DR

A 62-year-old diabetic man with a Salmonella-induced mycotic pseudoaneurysm was successfully treated with surgery and antibiotics, emphasizing the need for early diagnosis and combined treatment strategies.

Contribution

This case report presents a successful extra-anatomical surgical approach combined with targeted antibiotic therapy for a rare Salmonella-associated mycotic pseudoaneurysm.

Findings

Extra-anatomical femorofemoral bypass and ligation of the infected artery resolved the mycotic pseudoaneurysm.

Tailored antibiotic therapy based on culture results prevented complications and resolved the infection.

Follow-up imaging confirmed graft patency and aortic aneurysm stability post-treatment.

Abstract

Mycotic pseudoaneurysms, rare but life-threatening vascular conditions, result from infections of arterial walls, often involving Salmonella species. This case report details a 62-year-old man with diabetes presenting with a Salmonella-induced mycotic pseudoaneurysm of the left common iliac artery (CIA). The patient exhibited severe abdominal and radiating back pain, initially suggestive of gastrointestinal or urinary pathology. Diagnostic imaging revealed a thrombosed pseudoaneurysm with associated inflammatory changes, including wall enhancement and fat stranding, necessitating urgent intervention. Surgical management included extra-anatomical femorofemoral bypass with a polytetrafluoroethylene graft, ligation of the infected artery, and angioplasty of the right CIA to restore blood flow. Postoperative care with tailored antibiotic therapy, based on culture results, ensured the successful resolution of the infection and the prevention of complications. The patient achieved full recovery, with follow-up imaging confirming graft patency and stability of the aortic aneurysm. This case underscores the importance of early diagnosis, a multidisciplinary approach, and combined surgical and antibiotic strategies in managing mycotic pseudoaneurysms. It highlights the need for further research into optimizing management protocols for these complex infections.

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