Open Repair of Superior Mesenteric Artery Mycotic Aneurysm in an Adolescent Girl

Aneurysmal degeneration of the superior mesenteric artery (SMA) is rare, particularly in the pediatric population. We report the case of a 16-year-old female who presented with abdominal discomfort, back pain, fever, and vomiting. Extensive work-up revealed a 3-cm SMA aneurysm (SMAA) with surrounding inflammation. No bacterial growth was identified on current cultures, but a mycotic etiology was suspected due to recent episodes of suppurative hidradenitis. In addition to broad-spectrum antibiotics, she underwent transabdominal surgical intervention, including proximal and distal aneurysm ligation with aortomesenteric bypass, utilizing the reversed saphenous vein. Although endovascular intervention in the mesenteric arterial system has increased in utilization, patient-specific considerations, such as age and potential for infectious etiology, must drive therapeutic decision-making, with open surgical bypass being liberally employed.