Colonic ischemia after aortoiliac surgery. Apropos of 10 cases
Joyeux, A.; Seguin, J.; Mary, H.; Thévenet, A.
Annales de Chirurgie 39(6): 345-349
1985
ISSN/ISBN: 0003-3944 PMID: 4073781 Document Number: 264773
Ten cases of colic ischemia following aorta-iliac surgery are reported: 5 straight aneurysms, 3 ruptured aneurysms and 2 obstructive lesions of the aortic junction. They represent 2.9 percent of complications in aneurysmal surgery, and 0.3 percent of complications following operations for obstructive lesions. The factors affecting these complications are discussed (low flow, stricture or occlusion of the inferior mesenteric artery or its anastomotic branches). Among the clinical signs, diarrhea is present in all cases. There were general and abdominal signs in only two cases. Endoscopic examination is fundamental. Performed on eight patients, it was repeated five times in each case. Only one patient was treated medically. Surgical treatment was deferred from the third to the fifteenth day postoperatively in five cases. The mortality rate was 30 percent (3 out of 10). Prevention involves angiography with abdominal scan and the reimplantation of the inferior mesenteric artery. Ligation of the inferior mesenteric vein is to be avoided. Autotransfusion seems useful in correcting low blood flow. Criteria for evaluating gravity are proposed (age, hemafaecia, general and stage 3 signs under coloscopy). The authors consider that the reoperation can be deferred in the absence of these signs.