Ruptured Mycotic Aneurysm After Intravesical Instillation for Bladder Tumor

Annals of Vascular Surgery
Raffaella BerchiolliMauro Ferrari

Abstract

Intravesical instillation of Bacillus Calmette-Guérin (BCG) is an effective and widely used treatment for patients with in situ bladder cancer. Major complications are quite uncommon, but a systemic dissemination of the attenuated strain of Mycobacterium bovis is possible. Few cases of aortic rupture caused by M bovis infection are described in literature. A 70-year-old male, treated 3 months before with BCG instillation, presented to the emergency department because of a ruptured abdominal aortic aneurysm. The patient was hemodynamically stable, with a "hostile" abdomen. Therefore, an Endologix AFX endograft was deployed. During the postoperative period, his blood inflammatory markers increased, suspicious of a graft infection. Single-photon emission computed tomography (CT)/CT scan showed aortic increased uptake. Antibiotic therapy was continued, but after some days, the patient presented with hematemesis, and the CT scan showed an aortoenteric fistula. In emergency, the infected graft and aneurysm were removed, enteric fistula was closed, and an axillobifemoral bypass was performed. The patient died 25 days after endovascular aneurysm repair explantation. Despite the high suspicion of mycotic aortic aneurysm and graft infect...Continue Reading

Citations

Nov 23, 2019·APMIS : Acta Pathologica, Microbiologica, Et Immunologica Scandinavica·Emilie Stavnsbjerg LarsenIsik Somuncu Johansen
Oct 4, 2019·Vascular and Endovascular Surgery·Mohammad-Ali ShaikhMelissa L Kirkwood
Nov 26, 2020·Journal of Community Hospital Internal Medicine Perspectives·Harith A AlatabyJay M Nfonoyim
Feb 26, 2021·Journal of Medical Virology·Agnieszka JabłońskaIhor Huk
Jun 8, 2021·Journal of Vascular Surgery Cases and Innovative Techniques·Steve Thanh D PhamScott S Berman

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