A number of complications may occur in a patient with aortitis following Salmonella bacteremia. Aggressive surgical management can significantly reduce morbidity and mortality.
General complications:
(1) aneurysm with leak or rupture
(2) arterial emboli to kidney, brain or other organs
(3) pneumonia
(4) recurrent bacteremia
Complication
Thoracic Aorta
Abdominal Aorta
vertebral osteomyelitis
thoracic osteomyelitis
lumbar osteomyelitis
fistula
aortobronchial
aortoenteric (often duodenum)
abscess
psoas abscess, pelvic abscess
Imaging studies can be used to identify sites of arterial involvement and plan surgery:
(1) contrast enhanced CT scan to detect early changes in the aortic wall and periaortic soft tissue
(2) arteriography
General recommendations for management:
(1) Broad spectrum bactericidal antibiotics are given in high doses prior to surgery.
(2) The infected aneurysm is surgically resected with wide debridement.
(3) Extra-anatomic bypass grafting is used to maintain distal perfusion and avoid reinfection.
(4) Broad spectrum bactericidal antibiotics are continued for 6 weeks after surgery.
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