Dr. Khaled Al Brekeit

Successful repair of a contained rupture of mycotic aortic aneurysm in an 8-year-old child using polytetrafluoroethylene graft

This study reports on a contained rupture of mycotic abdominal aortic aneurysm secondary to coagulase negative staph successfully repaired with aorto bi-iliac polytetrafluoroethylene (PTFE) Gor-Tex graft. An 8-year-old Saudi male patient was found to have infective endocarditis by coagulase negative staph with mitral valve (MV) leaflet damage, which was repaired with mechanical MV. Post-cardiac surgery, he complained of intermittent abdominal and back pain, until he became more symptomatic and had a sudden abdominal pain. Ultrasound showed abdominal aortic aneurysm (AAA), as well as the CT scan showed contained posterior rupture of AAA. He was operated immediately and the aorta was repaired with bifurcated PTFE Gor-Tex graft. He tolerated the operation, and he was given antibiotic coverage according to sensitivity. Tissue culture of the aorta confirmed coagulase negative staph. The strong relation between infective endocarditis and mycotic aneurysm should make a high index of suspicion of developing abdominal aortic aneurysm in children. Utilizing the PTFE graft with an omental patch is safe and life saving.

Management of infected abdominal aortic aneurysm associated with vertebral destruction due to chronic leak

We report a case of a patient with an infected abdominal aortic aneurysm due to Staphylococcus versus Brucellar spine infection complicated by aortic aneurysm with chronic contained leak. A 75-year-old patient who had a history of Brucellosis 4 years ago presented one year later with 4.5 cm infra renal abdominal aortic aneurysm (AAA). He presented with aggravated acute abdominal pain radiating to the back and right hip, loss of weight, anorexia, and malaise. The CT-scan showed an AAA of size 6.5 cm involving infra-renal abdominal aorta with erosion of the body of lumbar vertebrae L3 and L4, and stretching of psoas muscle by a chronic contained posterior leak. Investigations showed erythrocyte sedimentation rate of 30, C-reactive proteins of 89, and the Brucella titer was negative. The diagnosis was infected aneurysm and the patient underwent axillo bifemoral bypass and ligation of aorta below the renal arteries. Tissue culture postoperatively showed coagulase negative Staphylococcus.