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Infectious anastomotic pseudoaneurysm complicating renal allograft: case report and review of literature

Authors Chung MMT, Chan YC, Law Y, Cheng SW

Received 19 September 2016

Accepted for publication 7 January 2017

Published 20 February 2017 Volume 2017:10 Pages 55—60


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Professor Pravin Singhal

Marvin MT Chung, Yiu Che Chan, Yuk Law, Stephen WK Cheng

Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong

Abstract: Infectious anastomotic pseudoaneurysm complicating renal transplant is rare, but probably under-reported with <30 cases worldwide. We report a 45-year-old man with hypertension, diabetes mellitus and end stage renal failure, who had a renal transplant anastomosed to the right external iliac artery and vein. Postoperatively, he made a slow recovery with malaise and persistent vague right iliac fossa discomfort. Ultrasound scan 1 month postoperatively showed perinephric collection, and fluid culture grew Enterococcus faecium and Pseudomonas aeruginosa. He was started on vancomycin, daptomycin and colistin. MAG-3 scan also showed suboptimal function in the renal allograft. His symptoms persisted with fever, and blood culture yielded P. aeruginosa. Repeated ultrasound scan, and subsequent computed tomography scan a few weeks later, showed perinephric collection and a large, 3.8×3.5 cm pseudoaneurysm posteromedial to the graft kidney. He underwent emergency graft excision, together with resection of the pseudoaneurysm with in situ reversed great saphenous vein interposition graft, and made a good recovery on hemodialysis. The aneurysm wall grew P. aeruginosa, and he was put on imipenem and cilastatin (tienam), colistin, ciprofloxacin and daptomycin. To our knowledge, this is one of very few cases in the world’s literature in which a P. aeruginosa infectious anastomotic pseudoaneurysm developed after a renal allograft.

Keywords: infectious anastomotic pseudoaneurysm, renal allograft artery, renal transplant, multidrug-resistant Pseudomonas aeruginosa, in situ interposition bypass graft

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