Endovascular Management of an Unusual Mycotic Aneurysm of the Inferior Mesenteric Artery: A Case Report

Abstract

Mycotic or infected Aneurysms (MA) are rare and typically affect major arteries. However, infective causes (mycotic) resulting in the formation of aneurysms in the Superior Mesenteric Artery (SMA) and Inferior Mesenteric Artery (IMA), despite their substantial rarity, are often symptomatic and may present acutely. Hereby, the authors present a case of a 29-year-old male patient who presented with abdominal pain, fever, and generalised weakness. Contrast-enhanced Computed Tomography (CECT) of the abdomen revealed peripherally enhancing hypodense collections with air foci along the subhepatic, peri-splenic, peri-gastric, bilateral paravertebral, and posterior pararenal spaces, extending to the lumbar region. Furthermore, multilobar saccular outpouching with irregular margins and soft-tissue thickening was observed, originating from the proximal IMA. Pigtail drainage was performed, and culture showed the growth of polymicrobial flora. Due to the irregularity of the aneurysm, with a high-risk of rupture, coil embolisation of the IMA aneurysm was carried out. The imaging characteristics of infected aneurysms should alert clinicians and radiologists to the diagnosis, enabling timely treatment, which may involve endovascular techniques.