A real dilemma: Management of multiple mycotic visceral aneurysms revealing severe endocarditis

• Main Authors: Zahira Zouizra, Gaël Biaou, Mouhcine El Mardouli, Rachid El Haouati, Drissi Boumzebra
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2018-01-01
• Series: Indian Journal of Vascular and Endovascular Surgery
• Subjects: Acute abdomen; bacterial; embolism; endocarditis; mycotic visceral aneurysms
• Online Access: http://www.indjvascsurg.org/article.asp?issn=0972-0820;year=2018;volume=5;issue=1;spage=50;epage=52;aulast=Zouizra

We present a case of endocarditis, which manifested as an acute-onset of abdominal pain, due to multiple mycotic visceral aneurysms in a 31-year-old man. We initially thought that the pain had a surgical visceral aetiology. However, following a computed tomography scan of the abdomen, he was subsequently found, to have multiple mycotic visceral aneurysms including: two aneurysms in two branches of the superior mesenteric artery; two mycotic aneurysms in the left renal artery associated with bilateral renal and splenic infarcts. Further investigations confirmed that the symptoms were related to mutilated mitral and aortic valves with a high risk of embolization. Our case highlights the surgical priority between repairing the life-threatening multiple aneurysms and the mitral and aortic valves that caused an endocarditis. First, we repaired the mycotic aneurysms by ligation and/or excision. This was then followed by replacement of the aortic and mitral valves. The patient recovered remarkably well.