Clostridium septicum aortitis: Report of two cases and review of the literature

J Vasc Surg. 2009 May;49(5):1304-9. doi: 10.1016/j.jvs.2008.11.058.


Clostridium septicum aortitis is a rare infection that has a strong association with occult colonic malignancy. To our knowledge, we report the 25th and 26th cases of C septicum aortitis in the English literature and make recommendations for its management. The first patient was a 75-year-old man who presented with abdominal pain. Computed tomography showed the presence of periaortic gas. He underwent aortic débridement and extra-anatomic bypass after blood cultures revealed C septicum. Four months after the initial presentation, he was readmitted with lethargy, found to have recurrent periaortic gas, and died. The second patient was a 76-year-old woman who presented with a 5-cm abdominal aortic aneurysm with surrounding retroperitoneal gas. She underwent emergency aortic ligation and retroperitoneal débridement. Her blood and intraoperative tissue cultures also grew C septicum. She had a prolonged postoperative course and ultimately died on hospital day 94. Both patients were found to have concurrent colon adenocarcinomas. C septicum aortitis is a lethal disease that necessitates prompt surgical intervention and appropriate antibiotic therapy. The strong association of C septicum with occult malignancy should prompt the astute clinician to undertake an exhaustive search for a neoplastic process.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adenocarcinoma / complications*
  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery
  • Aged
  • Aged, 80 and over
  • Aneurysm, Infected / diagnostic imaging
  • Aneurysm, Infected / microbiology*
  • Aneurysm, Infected / therapy
  • Anti-Bacterial Agents / therapeutic use
  • Aortic Aneurysm / diagnostic imaging
  • Aortic Aneurysm / microbiology*
  • Aortic Aneurysm / therapy
  • Aortitis / diagnostic imaging
  • Aortitis / microbiology*
  • Aortitis / therapy
  • Blood Vessel Prosthesis Implantation
  • Clostridium Infections / complications
  • Clostridium Infections / diagnostic imaging
  • Clostridium Infections / microbiology*
  • Clostridium Infections / therapy
  • Clostridium septicum / isolation & purification*
  • Colonic Neoplasms / complications*
  • Colonic Neoplasms / pathology
  • Colonic Neoplasms / surgery
  • Debridement
  • Digestive System Surgical Procedures
  • Fatal Outcome
  • Female
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Tomography, X-Ray Computed
  • Treatment Outcome


  • Anti-Bacterial Agents