Abdominal aortic aneurysm in the setting of Clostridium perfringens pancreatitis

• Published in: BMJ case reports Vol. 2017; p. bcr-2016-218549
• Main Authors: Karam, Paul Anthony, Moslim, Maitham A, Park, Woosup Michael, Morris-Stiff, Gareth
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 07.08.2017; BMJ Publishing Group
• Series: Case Report
• Subjects: Abdomen; Abdominal Pain - complications; Acute coronary syndromes; Alcohol; Aneurysms; Antibiotics; Aortic Aneurysm, Abdominal - complications; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Aortic aneurysms; Black; Case reports; Clostridium Infections - complications; Clostridium Infections - diagnosis; Clostridium perfringens; Cysts; Diabetes; Drainage - methods; Female; Gallstones; Gangrene; Humans; Incidental Findings; Infections; Intervention; Medical imaging; Middle Aged; Pain; Pancreatitis, Acute Necrotizing - complications; Pancreatitis, Acute Necrotizing - diagnostic imaging; Pathogenesis; Surgeons; Tomography, X-Ray Computed; Unusual Association of Diseases/Symptoms; USA/Canada; Veins & arteries; gastrointestinal surgery; vascular surgery; pancreatitis
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2016-218549

We report a case of a 56-year-old woman who presented with worsening abdominal pain located in the left upper quadrant together with abdominal distention, nausea and anorexia. One month prior to this admission, she had presented and had been diagnosed with concurrent acute pancreatitis and rapidly expanding abdominal aortic aneurysm. The aneurysm was prioritised over the pancreatitis and she underwent uncomplicated endovascular repair. Cross-sectional imaging was consistent with infected pancreatic necrosis and also revealed a large collection located in the anterior pararenal space with extensive gas formation. An image-guided fluid aspiration revealed Clostridium perfringens as the causative organism. She was treated by placement of large bore drains along with irrigation and targeted intravenous antibiotic for 6 weeks. The collections resolved completely and at 6 months follow-up she was well and symptom free.