Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
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Case Report

Volume 8, Number 2, February 2016, pages 168-174

Clostridium septicum Aortitis of the Infrarenal Abdominal Aorta


Figure 1.
Figure 1. Coronal CT showing intussusception at the junction between the transverse colon and the hepatic flexure.
Figure 2.
Figure 2. Aortitis with periaortic abscess and a pseudo aneurysm in the infrarenal abdominal aorta.
Figure 3.
Figure 3. Coronal CT showing mycotic aneurysm of the infrarenal aorta with gas bubbles.


Table 1. Cases of Aortitis Caused by C. septicum
First authorYearAgeGProcessLocationNeoplasmInterventionOutcome
Bridges [10]198168MAortic aneurysmInfrarenal abdominal aortaNoExtra-anatomical bypass (axillobifemoral bypass) and omental flapAlive
Semel [11]198460FAortic aneurysmAortic arch- ascending aortaTransverse colon cancerColon resection onlyDied of cardiac tamponade 20 h after colon resection
Kaufman [12]198862M-Bilateral iliac arteries and femoral arteriesNoneNoneDied
Narula [13]198876M-Right popliteal arteryCecal cancerResection of the aneurysmAlive
Momont [14]198985FAortic aneurysm and dissectionDissection of the ascending aorta and the archCecal cancerNoneDied (sepsis?)
Asplund [15]199080M-Right iliac arteryCecal cancerExtra-anatomical bypass (femorofemoral bypass)Alive (late death due to liver metastasis
Skipper [16]199070FAortitisSuprarenal Abdominal aortaNoDiagnosed at autopsyDied during surgery
Brahan [17]199070FAortic aneurysmAortic arch- descending aortaAscending colon cancerIn situ graft replacement, resection of a fistulas between the aneurysm and the pulmonary arteryAlive
Hurley [18]199167MAortic aneurysmInfrarenal abdominal aortaColonic polyps (rectum, splenic flexure and cecum)Rt. axillobifemoral bypass followed by resection of the aneurysm, It. Ax-F bypass was performed because of infection of the rt. Ax-F bypassAlive 9 months postoperatively
Christensen [19]199374FAortic aneurysmJuxtarenal abdominal aorta-NoneDied
Messa [20]199577MDouble aortic aneurysmDistal descending aorta and infrarenal abdominal aorta (double aneurysms)Sigmoid polyp cancerExtra-anatomical bypass (axillobifemoral bypass) for the abdominal aorta, and in situ graft replacement of the descending aorta and omental flapAlive
Murphy [21]199678MAortic aneurysmProximal descending aortaSigmoid polypsIn situ graft replacement, esophagectomyAlive after 6 months
Sailors [22]199674FAortic aneurysmThoracoabdominal aorta-In situ replacementDied presumably due to rupture of pseudoaneurysm in the distal anastomosis
Monsen [23]199781MAortic dissectionDissection of the whole aorta (rupture at the infrarenal abdominal aortaCecal cancerIn situ graft repairDied 6 h after surgery
Montoya [24]199778MAortic aneurysmDescending aortaCecal cancerNoneDied 16 h after admission
Cohen [25]199877MAortic dissection and abscessesAortic root and Ascending aortaCecal adenocarcinomaRt. hemicolectomyDied 23 days post-op
Johnson [26]199978MAortic aneurysmInfrarenal abdominal aorta-NoneDied 6 days after admission
Morrison [27]200171MAortic aneurysmThoracoabdominal aortaAscending colon cancerIn situ graft replacementAlive
Al Bahrani [28]200163MAortic aneurysmInfrarenal abdominal aortaAscending colon cancerIn situ graft replacement?Alive?
Zenati [29]200287MAortic aneurysm and dissectionAbdominal aortaCecal adenocarcinomaNoneDied in the hospital at day 6
Munshi [30]200278MAortic aneurysmInfrarenal abdominal aortaCecal adenomaNoneDied 1 month after discharge
Takano [31]200369MAortic aneurysmInfrarenal abdominal aortaAscending colon cancerIn situ graft replacement, rectus abdominal muscle flapAlive
Liechti [32]200355MAortic aneurysmInfrarenal aortaTransverse colon adenocarcinomaTransverse colectomy and exploration of the aorta without resectionDied 5 months after admission
Davies [33]200363MAortic aneurysmInfrarenalUnknownAxillobifemoral bypassDied 2 days post-op
Rucker [34]200477FAortic aneurysmInfrarenalCecal adenocarcinomaAxillobifemoral bypass and right colectomyDied 42 days post-op
Rucker [34]200491FAortitisAbdominal aortaAscending adenocarcinomaRt. hemicolectomyUnknown
Evans [35]200491FAortitisAbdominalTransverse colon adenocarcinomaExtended Rt. hemicolectomyDied at 5 months
Creed [36]200477FAortitis then AneurysmInfrarenal AneurysmColon cancer, poorly differentiated adenocarcinomaRt. hemicolectomy + axillobifemoral by pass + resection of infrarenal and two common Iliac arteriesDied on the 42nd POD 2/2 sepsis and MOF
Mohamed [37]200682MAortic aneurysmJuxtarenalAscending adenocarcinomaIn situ graft, Rt. hemicolectomyAlive
Asciutto [38]200771MAortitis then Aortic ruptureJuxtarenal Abdominal aneurysmColon carcinoma, ascending colonRt. hemicolectomy, then aortic replacement with dacron tube + IV AbxAlive
Seder [9]200875MAneurysmInfrarenalAscending adenocarcinomaRt. hemicolectomy and axillobifemoral bypassDied at 4 months due to recurrent aortitis
Seder [9]200876FAortic aneurysmJuxtarenalCecal adenocarcinomaAxillobifemoral bypass and right hemicolectomyDied at 94 day post-op
Yang [39]200922MAortitis then aortic dissectionWhole length of aortaNoNothing was done, diagnosed at autopsyDied
Eplinius [40]201032MAortic dissectionThoracic aortaNoDiagnosed at autopsyDied
Moseley [41]201082MAortitisInfrarenal and Rt. common iliac arteryCecal tubulovillous adenoma (high grade)Suppressive IV Abx + Rt. hemicolectomy (Zosyn, Vanc and Levoflox) then IV cefepime and metronidazole (Pt. refused surgery)Survival for 75 days after admission and died 2/2 ischemic heart dis.
Tsukioka [42]201374MAortic aneurysm C. difficleRt. common iliac arteryNoExcision of infrarenal and both common Iliac arteriesAlive
Lintin [43]201478FAortic aneurysmArch of aorta and thoracic aortaCecal adenocarcinoma and hepatic metastasisHybrid endovascular repair + laparoscopic Rt. hemicolec. + liver metastasis resectionAlive
Al Hadi [44]201463MAortic aneurysmAortic arch to mid thoracic aortaColorectal cancerRt. hemicolectomy and he did not make it to the vascular surg.Died before the vascular surgery
Subramaniam [45]201416FAortic dissectionAscending thoracic aortaNoDiagnosed at autopsyRapid course of events, died before diagnosis
Shah [46]201578MAortic aneurysmInfrarenal aortaColon cancer, hepatic flexureInfrarenal resection and bypass grafting + IV AbxAlive


Table 2. Summary of Surgical and Medical Management
Total number of patients with reported Clostridium aortitis40
Average reported age70.5 years old
Aortic injury
  Aortic aneurysm alone25 (62.5%)
  Aortic dissection7 (17.5%)
  Aortitis alone4 (10.0%)
  Aortic rupture1 (2.5%)
  Unknown process3 (7.5%)
  Surgical and medical Rx24 (60.0%)
  Medical Rx only5 (12.5%)
  None11 (27.5%)
Mortality rate following intervention
  Surgical and medical Rx2 out of 23 (8.6%)
  Medical Rx only4 out of 5 (80%)
  None12 out of 12 (100%)
Total reported survivors22 (55.0%)
Total reported mortalities17 (42.5%)
Unknown outcome1 (2.5%)