2025年 · 第105卷第17期

A 70-year-old male went to the Department of Vascular Surgery of the Second Xiangya Hospital of Central South University for "finding a pulsatile abdominal mass combined with high fever (>39 ℃) for 1 week". Deny abdominal pain and diarrhea, no nausea, vomiting, no melena, blood in the stool, jaundice and other symptoms. One month ago, he was discharged from the local hospital due to lumbar spine infection after conservative treatment. He had no history of abdominal surgery and trauma, and no history of special medication. Admission physical examination: blood pressure 120/80 mmHg (1 mmHg =0.133 kPa), body temperature 39.0 ℃, pulse 99 beats/min, clear mind, soft abdomen, a pulsatile mass about 4 cm ×5 cm in size can be palpable in the upper abdomen, without tenderness and rebound pain. Laboratory test at admission: white blood cells 7.78×10⁹/L, neutrophil ratio 72.4%, erythrocyte sedimentation rate 88 mm/1h, C-reactive protein 69.1 mg/L, procalcitonin 0.356 μ g/L; Blood culture showed streptococcal infection, rheumatic immunity and vasculitis tests were negative. Total aortic CTA revealed a 52 mm ×45 mm giant pseudoaneurysm in the middle of the superior mesenteric artery (red arrow in Figure 1, white arrow in Figure 2). Based on medical history, physical examination and imaging, the patient was diagnosed with pseudoaneurysm of the superior mesenteric artery secondary to lumbar spine infection. Considering that the patient is currently complicated with hyperthermia, the pathogenic susceptible antibiotic cefoperazone/sulbactam is given to anti-infection (3 g, once every 8 hours). After the patient's body temperature is normal for 3 consecutive days, digital subtraction angiography (DSA) of superior mesenteric artery is performed under local anesthesia. Superior mesenteric artery pseudoaneurysm is confirmed during the operation, and superior mesenteric artery stent implantation is performed. After stent implantation, re-angiography shows that the pseudoaneurysm is completely isolated and the branches have good blood supply (Figure 3). Cefoperazone/sulbactam anti-infective therapy was continued for 3 months and clopidogrel anti-platelet therapy was given for 6 months. During the 4-year follow-up, the patient recovered well, and no symptoms such as aneurysm recurrence and visceral ischemia were seen.