19 October 2025
: Case report 
Escherichia coli-Induced Aortitis and Aortic Perforation: A Case Study and Literature Review
Challenging differential diagnosis, Diagnostic / therapeutic accidents, Unusual setting of medical care, Educational Purpose (only if useful for a systematic review or synthesis), Rare coexistence of disease or pathology
Hiba Abdelkareem ABCDEF 1, Saif Aldeen Jabarin ABEF 1, Ahmad Farhoud B 2, Yuval Schwartz AD 1, Ilya Goldin BDE 3, Gabriel Munter ADEG 1,2*DOI: 10.12659/AJCR.949202
Am J Case Rep 2025; 26:e949202
Table 2 Patients with E. coli aortitis reported in the English literature.
| Report year [Ref] | Sex, age (years) | Imaging findings | Surgical intervention | Medical treatment and duration (weeks) | Outcome | Follow up, months |
|---|---|---|---|---|---|---|
| 1978 []8 | F, 64 | CT: Ascending thoracic aorta dilation containing gas density | NA | Appropriate antibiotics (NA) | Died | NA |
| 1978 []8 | F, 61 | CT: Aortic arch enlargement containing gas density | NA | Appropriate antibiotics (NA) | Died | NA |
| 1989 []9 | M, 57 | CT: Ruptured aneurysm | Axil-bifem bypass | Antibiotics 8 weeks | Survived | 26 |
| 1989 []9 | F, 55 | CT: 8 cm aortic aneurysm + rupture | Primary lateral closure | Antibiotics 24 weeks | Survived | 2 |
| 1989[]9 | F, 61 | CT: 2–6 cm aortic dilation | Axil-bifem bypass + iliac bypass | Antibiotics8 weeks | Survived | 24 |
| 1996 []10 | M, 58 | US: 5 cm leaking aneurysm | Axilbifem bypass | CXM, Metro, Gent (NA) | Survived | 60 |
| 2001 []11 | M, 68 | CT: 4.5 cm saccular, lobulated perivisceral aortic aneurysm | Aneurysmectomy + anastomosis with prosthetic graft + debridement | IV Metro, Vanc & Ceftaz, 72 h then IV Cip+Cefotetan, 6 weeks | Survived | 26 |
| 2002 []12 | M, 57 | CT: Descending aorta intramural hematoma + aneurysm | Aneurysmectomy + prosthetic graft | IV AG & Vanc,then Cip+Rif, 12 wks | Survived | 3 |
| 2008 []13 | M, 79 | CT: Abd aortic pseudoaneurysm + gangrenous gas formation | During surgery: aortic rupture, fem bypass | Vanc, Mero + Metro (NA) | Survived | NA |
| 2009 []14 | M, 78 | CT: Abd aortic aneurysm. >2 weeks: 2 new thoracic pseudo-aneurysms | No intervention due to comorbidities | IV Mero, 16 weeks | Survived | 3 |
| 2009 []15 | M, 41 | MRA: Infrarenal abd aortic aneurysm with thrombosis | Aorto-bi-iliac grafting | Antibiotics (NA) | Survived | 5 |
| 2011 []16 | M, 65 | CT: 5.3 cm distal arch aneurysm. >2 weeks, 7 cm | Stent-graft procedure | IV Vanc + Gent, 2 weeks, then Carb + Gent | Survived | 12 |
| 2011 []17 | M, 84 | CT: Periaortic soft tissue mass; later-pseudoaneurysm | Aortectomy with prosthetic graft | Cef + Clinda, then Levo (24 weeks) | Survived | NA |
| 2011 []18 | M, 64 | CT: AAA with contained rupture | Aneurysmectomy with prosthetic graft | IV antibiotics (NA) | Survived | NA |
| 2012 []19 | M,78 | CT: Aortic thickening and mural thrombus | Axil-bifem bypass, resection of inf aorta | IV Ceftriaxone (6 weeks) | Survived | 6 months |
| 2012 []20 | M,78 | CT: aortic thickening with mural thrombus | Axil-bifem bypass and surgical debridement | IV Ceftriaxone (6 weeks) | Survived | NA |
| 2012 []7 | F, 85 | CT: Aortic arch large mycotic aneurysm | Unfit for surgery | IV Piperacillin-tazobactam | Died | – |
| 2012 []21 | M, 75 | CT: Periaortic soft tissue infiltration & fluid accumulation | EVAR | IV antibiotics (NA) | Survived | 35 |
| 2013 []22 | F, 81 | CT: 2 cm aneurysm + air-density spots, anterior asc aorta | Aortectomy with prosthetic graft | IV Mero, Cefo+Gent (2 weeks), then PO Cefca, 12 weeks | Survived | 10 |
| 2014 []23 | M, 66 | CT: Aortic wall thickening & periaortic stranding | In situ repair with aortic homografts | Antibiotics (NA) | NA | NA |
| 2017[[]24 | M, 67 | CT: 4.9 cm aortic dilation. At surgery: hematoma and rupture | Aneurysmectomy with prosthetic graft | Amoxi/Clav – 6 weeks | Survived | 9 |
| 2017 []25 | M, 65 | CT: infected aortic aneurysm with multiple abscesses | Resection of aortic aneurysm | 6 weeks antibiotics (NA) | Survived | 18 |
| 2017 []26 | M, 71 | CT: Infected abd aortic aneurysm + contained rupture | Open debridement and in situ implantation of a rifampin-soaked prosthetic graft | IV Ceftriaxone – 6 weeks | Survived | NA |
| 2020 []27 | M, 84 | CT: Aortic arch and descending aorta + abscess formation | CT-guided percutaneous drainage | IV Ceftriaxone, then Mero, then TMP-SXZ (NA) | Survived | 12 |
| 2022 []28 | M, 85 | CT: distal arch aneurysm, with signs of impending rupture | TEVAR | Mero (4 weeks) | Survived | 18 |
| 2020 []29 | M,78 | CT: 0.5 cm infected abdominal aneurysm | Aneurysmectomy with prosthetic graft | Ceftriaxone + Metro | Survived | 4 |
| 2022 []30 | M, 62 | CTA: 5.3 cm aortic aneurysm + periaortic inflamm | Resection + graft | IV Cip + Clinda, then Pip-Tazo | Died | – |
| 2022 []31 | F, 82 | CT: inf aneurysm of descending aorta | No surgical intervention | IV Cefepime, then IV ceftriaxone | Died | – |
| 2023[]32 | M, 66 | CT: Abd aorta wall gas collection. >2 weeks: aneurysm | EVAR and stent | IV Ceftria, then TMP-SXZ + Erta (8 weeks) | Survived | (NA) |
| 2023 []33 | M, 69 | CTA: 3.5 cm AAA, with gas.Increase to 7.5 cm | Open surgery, resection and graft | Mero | Died | – |
| 2023 []34 | F, 83 | CT: Irregular distal arch aneurysm | Arch replaced with prosthetic graft | Mero, then Cef, then Pip-Tazo | Survived | 6 |
| 2023 []35 | F, 82 | CT: 0.61×0.4 cm infected aortic arch aneurysm | Arch replacement with omental patch | Antibiotics >6 weeks (NA) | Survived | 12 |
| 2023 [CR] | M, 82 | CT: left periaortic collection + thickening, pseudoaneurysm | EVAR | IV Ceftriaxone, then Cefuroxime – 8 weeks | Died | 4 |
| * The cultures revealed and methicillin-resistant (MRSA). AAA – abdominal aortic aneurysm; Abd – abdominal; AG – aminoglycoside; Amoxi/Clav – amoxicillin-clavulanic acid; Asc – ascending aorta; Axil-bifem – axillo-bifemoral bypass; Carb – carbapenem; Cef – cefepime; Cefca – cefcapene; Cefo – cefozopran; Ceftaz – ceftazidime; Ceftria – ceftriaxone; Clinda – clindamycin; Cip – ciprofloxacin; CT – computed tomography; CTA – CT angiography; CXM – cefuroxime; Erta – ertapenem; EVAR – endovascular aneurysm repair; Fem – femoral artery; Gent – gentamycin; Inf – infected; IV – intravenous; Inflamm – inflammation; Levo – Levofloxacin; Mero – meropenem; Metro – metronidazole; Mo – months; MRA – magnetic resonance angiography; NA – not available; Pip-Tazo – piperacillin-tazobactam; PO – per os, oral; Rif – rifampin; TEVAR – thoracic endovascular repair; TMP-SXZ – trimethoprim-sulfamethoxazole; US – ultrasound; Vanc – vancomycin. [CR] – current report. | ||||||