Mycotic Aneurysm After Metallic Foreign Body Ingestion
Bendix S, Rteil A, Potti C, Chamogeorgakis T, Lace B, Woodward A, and Kabbani L. Mycotic Aneurysm After Metallic Foreign Body Ingestion. Journal of Vascular Surgery 2020; 72(3):e304-e305.
Journal of Vascular Surgery
Objective: The esophagus is a frequent foreign body impaction site. We present a case of foreign body ingestion complicated by erosion into the aorta, causing a mycotic aneurysm.
Methods: We introduce the case of a 60-year-old man with abdominal pain, nausea, fatigue, and fevers. Blood cultures grew out gram-positive cocci. A computed tomography (CT) scan revealed a distal thoracic aortic saccular aneurysm, with a 2.8-cm linear metallic body penetrating the inferior border of the aneurysm, and intraluminal thrombus formation (Fig, A). CT of the abdomen revealed portal vein thrombosis and splenic and hepatic abscesses. Esophagogastroduodenoscopy was unremarkable.
Results: The patient was started on the appropriate antibiotic therapy. He was then taken to the operating room for an open thoracoabdominal aortic aneurysm repair with an interposition cryopreserved graft, with an intercostal muscle flap (Fig, B). A metal bristle was removed (Fig, C). He had an uneventful postoperative course and was discharged home on postoperative day 17. Follow-up CT angiography showed resolution of the infection and satisfactory repair (Fig, D). Postoperative esophagram showed no esophageal injury.
Conclusions: We describe a case of a bristle from a metallic barbecue brush that was ingested. This penetrated the esophagus, causing a mycotic aneurysm with septic embolization to the spleen and liver. Our successful treatment approach involved open aortic repair with an interposition cryopreserved graft and an intercostal muscle flap.