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Journal of Case Reports
Ruptured Mycotic Superior Mesenteric Artery Aneurysms and Infective Endocarditis
Hentati Rim1, Tlili Rami2, Azaiez Fares2, Zouari Fatma2, Zayed Soufien1, Ben Romdhane Rim2, Ben Ameur Youssef2 
Mongi Slim La Marsa Hospital; Faculty of Medicine, 1University of Sfax, Tunisia and 2University of Tunis El-Manar, Tunis, Tunisia.
Corresponding Author:
Dr. Hentati Rim
Email: hentati68@yahoo.fr
Received: 24-MAY-2019 Accepted: 20-JUL-2019 Published Online: 05-AUG-2019
DOI: http://dx.doi.org/10.17659/01.2019.0042
Background: Aneurysms of the superior mesenteric artery (SMA) and its branches are uncommon complication of infective endocarditis (IE) and have a high rate of rupture and mortality. Case Report: A 50-year-old female was diagnosed and treated for IE with good initial evolution. During pre-surgery evaluation, the patient developed hemorrhagic shock. Computed tomography angiogram revealed hemoperitoneum and contrast extravasations due to rupture of aneurysm originating from an SMA’s branch. The patient was transferred for urgent surgery. On laparotomy large, inflamed, pulsatile mesenteric mass with free blood in the pelvis was found. Evidence of necrotic small bowel was detected and resection of 25 cm with ileostomy was performed and surgery for restoring bowel continuity after ileostomy was programmed three months later with good results. Conclusion: Although main trunk and superior mesenteric artery (SMA) branch aneurysms account for only 5.5% of all visceral artery aneurysms, early identification and expedient management are very important given an associated 38-50% rupture rate and 30% mortality.
Keywords : Aneurysm, Angiography, Endocarditis, Ileostomy, Superior Mesenteric Artery.
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