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A Precursor of Aortic Rupture and Pseudoaneurysm Formation

Samuel E. Wilson, MD; H. Earl Gordon, MD; Peter B. Van Wagenen, MD

Arch Surg. 1978;113(10):1163-1166.

Abstract
• Salmonella arteritis developed in three patients with subsequent arterial rupture and pseudoaneurysm formation. They had a one- to two-week history of chills and fever, and blood cultures were positive for salmonella. Pulsatile, tender abdominal masses developed in two patients with aortic infection while they were hospitalized. The third patient's femoral artery infection presented as a painful swelling behind the knee. Arteriography demonstrated large vessel rupture with pseudoaneurysm formation and allowed a planned operation in each case. The infected aortic aneurysms were totally excised, the aortic stump oversewn, and the retroperitoneum drained through the flank. Axillobifemoral grafts were constructed to bypass the infection area. Antibiotics effective against salmonella (ampicillin sodium, amoxicillin trihydrate, or chloramphenicol) were given for six weeks postoperatively. All three patients are alive without evidence of further infection. Recognition that microbial arteritis may be a complication of salmonella infections, particularly when Salmonella choleraesuis and Salmonella typhimurium are cultured, will lead to earlier detection of vascular lesions.

(Arch Surg 113:1163-1166, 1978)

Author Affiliations
From the Department of Surgery (Drs Wilson and Gordon), UCLA School of Medicine, and the Surgical Service (Drs Wilson, Gordon, and Van Wagenen), Veterans Administration Wadsworth Hospital Center, Los Angeles.

Footnotes
Accepted for publication May 3, 1978.

Read before the annual meeting of the Southern California Chapter of the American College of Surgeons, Santa Barbara, Calif, Jan 20, 1978.

Reprint requests to Surgical Service (691/112K), Veterans Administration Wadsworth Hospital Center, Los Angeles, CA 90073 (Dr Wilson).

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