What began as a persistent fever and worsening stomach pain turned out to be Central India’s first successfully treated case of an infected aortic aneurysm, or “mycotic aneurysm”, a rare and life-threatening condition.
With the aneurysm at risk of rupturing, Nagpur’s vascular surgeons faced an 8-hour race against time to remove the infected aneurysm, reconstruct the aorta and save the patient’s life.
It All Started With a Fever
A 63-year-old man was referred to the CIIVES Dept (सि-व्स विभाग) with a history that initially seemed like a simple problem.
He had persistent fever, abdominal pain and nausea. Over time, the abdominal pain had gradually intensified.
An ultrasound revealed a swelling or mass in the abdomen, prompting further investigation. But then this seemingly innocent abdominal mass turned out to be a thoraco-abdominal aortic aneurysm.
The CT scan revealed a 6 × 6.5 cm abdominal aortic aneurysm (AAA) extending up to the suprarenal segment, close to the diaphragm and involving arteries supplying the main abdominal organs and intestines.
But the size and location were not the only concerns.
The imaging suggested that this was not simply an aneurysm caused by the usual weakening of the aortic wall.
There was evidence of infection.
When an Aneurysm Becomes Infected
An aortic aneurysm occurs when a weakened section of the aortic wall balloons outward. When infection reaches the vessel wall, however, it can cause inflammation and rapidly weaken the aorta.
An infected aortic aneurysm is traditionally called a “mycotic aneurysm.” Despite the name, most are caused by bacteria rather than fungi.
In this case, blood cultures confirmed a bacterial infection.
But one crucial question remained: How extensive was the infection?
A PET scan showed localised uptake around the aneurysm, suggesting active infection in the region. Combined with the CT findings, persistent fever and blood culture results, the diagnosis became clear:
An infected thoraco-abdominal aortic aneurysm (TAAA).
And now the real challenge began.
The TAAA sat near the diaphragm, close to major branches of the aorta, making an already dangerous condition far more complex to treat.
Pandora’s box had just been opened.
Why the Case Was Challenging
This aneurysm repair was not a straightforward textbook procedure. For an open surgical repair to be successful, the team had to overcome four major challenges:
1. A Difficult Location
The aneurysm was in the thoracoabdominal aorta, meaning the aorta spanning between the chest and the abdomen. The aneurysm was just beyond the celiac artery and close to the diaphragm: an anatomically complex region where the aorta gives off branches for the vital organs.
2. An Infected Aorta
This was not just a weakened aortic wall. The aneurysm itself was infected, making infection control and removal of the diseased segment critical.
3. Maintaining Blood Flow
The aorta supplies blood to several vital organs through its major branches. The repair had to maintain adequate blood flow throughout the procedure and after reconstruction.
4. Reconstructing the Aorta
The infected aneurysmal segment had to be removed and replaced with a bovine graft, followed by a secure, blood-tight anastomosis.
The Open Aneurysm Repair: An 8-hour Race Against Time
With the aneurysm infected and at risk of rupture, there was little room for delay.
The vascular surgeons at the CIIVES Dept performed an 8-hour-long surgery to remove the infected aneurysmal segment and replace it with a bovine graft, while working to maintain blood flow to the vital organs.
We are happy to share that the procedure was successfully completed, and the patient is recovering well.
This is a reminder that some of the toughest cases that challenge a surgeon’s skill are the most rewarding!
Take Home Message
Most aortic aneurysms do not announce themselves with dramatic symptoms. Many are discovered incidentally, which is why recognising risk factors and screening appropriate high-risk individuals is your best bet.
5 Risk Factors for Aortic Aneurysm
- Increasing age, especially above 60yrs
- Smoking
- High blood pressure
- Family history of aortic aneurysm
- History of atherosclerosis or cardiovascular disease
Persistent fever with unexplained or worsening abdominal or back pain should not be dismissed.
An infected aortic aneurysm is rare, but it can progress rapidly and may lead to aortic rupture with life-threatening internal bleeding or secondary infection.
When symptoms persist without a clear explanation, sometimes the most important step is simply to look beyond the obvious.
Have you been diagnosed with an aortic aneurysm or another vascular condition?
Early evaluation by a vascular surgeon can help determine the severity of the condition and whether monitoring, medication or intervention is appropriate.