ORIGINAL ARTICLE   

Chirurgia 2019 August;32(4):160-5

DOI: 10.23736/S0394-9508.18.04831-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Salmonella aortitis: a single center’s experience

Jiri MOLACEK ^{1, 2} ✉, Vladislav TRESKA ^{1, 2}, Vaclav OPATRNY ¹, Karel HOUDEK ¹, Bohuslav CERTIK ¹, Richard SULC ¹, Jan BAXA ³

¹ Department of Vascular Surgery, Plzen University Hospital, Plzen, Czech Republic; ² Faculty of Medicine, Charles University, Plzen, Czech Republic; ³ Department of Imaging, Plzen University Hospital, Plzen, Czech Republic

BACKGROUND: Under normal circumstances, the aorta is very resistant to infections, but in some specific situations, even the aorta can be affected by infectious inflammation. Salmonella is responsible for about one-third of all cases of infectious aortitis.
METHODS: The authors retrospectively evaluated the group of patients from 2012 to 2016. During this period, 10 patients with Salmonella infection of the abdominal aorta were treated in our institution. The mean duration of the follow-up period was 3.5±0.5 years.
RESULTS: The mean age in the presented population was 74 years (range 58-90 years). The population included 6 men and 4 women. The patients were referred to our center with the following symptoms: perforation of non-dilated aorta (N.=4), acute symptomatic aortitis (N.=2), symptomatic abdominal aortic aneurysm (N.=2), abdominal aortic aneurysm rupture (N.=2). Salmonella enteritidis was detected by culture in 8 cases (80%), and Salmonella species in 2 cases (20%). Surgical treatment, subrenal aortic resection, extensive debridement and in situ revascularization (6 silver grafts, 1 antibiotic-bonded graft, 1 arterial “fresh” allograft) were selected in 8 patients (80%). In one case (10%), we selected endovascular treatment (stent graft insertion and antibiotic treatment) in a patient with a pseudoaneurysm resulting from aortic perforation, and in one case (10%) we decided for conservative therapy alone. The 30-day mortality was zero, one polymorbid patient died on day 42 from multiple organ failure (MOF) after resection for perforated aortitis. The morbidity was 40%. During the follow-up, we registered one vascular graft infection.
CONCLUSIONS: Our experience shows that acute Salmonella aortitis is not a rare finding, and it is necessary to consider this a serious diagnosis, in particular in elderly, compromised and immunodeficient individuals.

KEY WORDS: Salmonella enterica - Aneurysm - Endovascular procedures