An infective aneurysm is a rare disease, mostly caused by hematogenous dissemination of infective endocarditis or together with septic emboli[1, 5]. Infective aneurysms usually occur in intracranial, visceral, and limb arteries, while intracranial arteries are more frequently involved. Among extracranial vessels, ulnar arteries in extremity arteries, popliteal arteries, and coronary arteries have been reported[6].
In patients with infective endocarditis, symptomatic infective aneurysms due to septic embolus drop embolization are relatively rare. Because the source of septic emboli falls off as endocardial excrescences, in most cases, such as in multiple emboli, they pose greater distress for disease diagnosis and treatment[7].
To date, there is no standard treatment for infective aneurysms caused by septic embolus drop embolization in infective endocarditis. Antibiotic therapy in combination with surgery is the most common treatment. The surgery aims to achieve microbiota-derived control, prevent rupture, and reestablish the blood flow in the surgical area[8]. For patients with asymptomatic embolism, the option may be to undergo open surgery or vascular intervention after the first cardiac surgery to control the microbial source, pending improvement of the condition of the patient. For patients with similar conditions to our report, simultaneous heart valves combined with abdominal surgery could also be considered. Because embolization was mostly multiple, the surgical option only treated the aneurysms arising from the mesenteric embolization suggested during the preoperative examination. Preoperative and postoperative antibiotic symptomatic treatment is also essential in diagnosing and treating the disease. In our case, the patient had multiple visceral infarctions, neither of which were managed during the surgery. After resolving the source of the causative microorganism and a period of symptomatic treatment with antibiotics, the patient did not have overt manifestations of infection or infarct progression on follow-up. This illustrates that in patients with poor underlying conditions who cannot tolerate surgical management, symptomatic treatment with antibiotics alone is a therapeutic option without an indication for emergency surgery. With the continuous development of interventional methods, endovascular techniques provide an interim safeguard or therapeutic option for patients unable to undergo open surgery[9, 10].
Reviewing the diagnosis and treatment process, we found that for infective aneurysms caused by septic embolic drop embolism from infective endocarditis, the diagnosis is based on CT; however, confirmation of the diagnosis is performed with blood pathogen culture[11]. NNegative results may be reflected in 30% of blood cultures of patients with suspected infected aneurysms, a condition that can only be confirmed by surgical tissue pathogen identification.
The question of whether early screening can lead to more treatment options raises new options for further research. In a case report of infective aneurysms of the superior mesenteric artery due to infective endocarditis, three had no abdominal-related symptoms. After the diagnosis of infective endocarditis, a short interval of CT examination earlier suggested a possible infective aneurysm[12, 13]. Before the onset of symptoms, patients are treated prophylactically, preventing surgical treatments such as bowel resection[14].
We highlight the need to perform the necessary systemic vascular examinations in patients with infective endocarditis. In patients with a history of endocarditis and a chief complaint of abdominal pain and fever, embolism due to septic embolic drop should be included in the differential diagnosis.