Clinical-Medical Image - International Journal of Clinical & Medical Images (2016) Volume 3, Issue 4
Author(s): Ben Jma Hla, Ghorbel Nesrine, Ben Jma Tarak, Dhouib Faten, Souissi Iheb, Masm
Abstract; Mycotic aneurysms of the superior mesenteric artery are rare. Streptococcus infections are the most common etiology of these aneurysms. We report a case of a mycotic aneurysm of the superior mesenteric artery caused by Streptococcus equi, in a 55-yearold-patient, managed by aneurysmorraphy.
Case Presentation:palpation. A blood culture grew Streptococcus equi. A CT-scan confirmed a 2-cm saccular aneurysm arising from the main trunk of the superior mesenteric artery (Figures 1 and 2). A trans-thoracic echocardiography excluded the diagnosis of endocarditis. The patient received antibiotic treatment by Ampicillin. And the patient underwent surgery through a thoracotomy in the eighth intercostal space, a lombotomy, and a circular incision of the diaphragm. Also, a femoro-femoral cardio-pulmonary bypass was performed after access and cannulation of the femoral vein and artery. After dissection of the supra-renal aorta, the celiac trunk, the superior mesenteric artery was dissected and controlled.
A saccular aneurysm of 2 cm × 3 cm was observed (Figure 3). The aorta was clamped in his supra-mesenteric segment. The mesenteric aneurysm was opened, a bacteriological specimen was took from the purulent collection, and an aneurysmorraphy was performed. Histological examination of a fragment of the aneurysm revealed severe infiltration of inflammatory cells, such as neutrophils, and a proliferation of granulation tissue in the arterial wall. Bacteriological culture of the specimen grew a Streptococcus equi. The patient’s recovery was unremarkable, and antibiotic therapy was maintained for 6 weeks.