Acute Colorectal Ischemia after Aortic Surgery: Pathophysiology and Prognostic Criteria

Farkas, Jean-Christophe; Calvo-Verjat, N.; Laurian, Claude; Marzelle, J.; Jm, Fichelle; Gigou, Frédéric; Bleriot, J. P.; Dazza, F; Carlet, Jean; Cormier, J M

doi:10.1007/bf02042730

Cited by 28 publications

(11 citation statements)

References 28 publications

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“…The quoted incidence is 2% (ranging from 0.2% to 10%). Mortality in this condition is 40 to 50% and approaching 90% if there is full thickness bowel wall ischaemia (31). To reduce the risk of colonic ischaemia following aortic surgery, it is imperative that the surgeon is satisfied with the colour and perfusion of the left colon prior to closure of the laparotomy.…”

Section: Iatrogenic Intestinal Ischaemiamentioning

confidence: 98%

Acute Mesenteric Ischaemia

Menon

Amin

Mohammed

et al. 2005

Acta Chirurgica Belgica

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Acute Mesenteric Ischaemia (AMI) is an uncommon vascular emergency where the diagnosis is often difficult and overlooked and delay in diagnosis results in a grave outcome. Although extravascular events like intussusception, volvulus, strangulated hernia and adhesive obstruction in neglected cases can result intestinal gangrene, this contribution will be limited to acute mesenteric ischaemia as a primary event. AMI consists of four pathologic processes (arterial thrombosis, arterial embolism, Non Occlusive Mesenteric Ischaemia (NOMI) and mesenteric venous thrombosis (MVT)) with similar clinical presentation and one potentially fatal pathological endpoint- intestinal gangrene. The clinical setting and the patient's risk profile often give the clue to the etiological process while the presentation is dominated by severe unrelenting abdominal pain out of proportion to the physical findings. The key to the successful management depends on the surgeon's ability to suspect the diagnosis, pursue appropriate investigations and institute aggressive treatment. The mortality remains high due to difficulty and delay in the diagnosis.

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Section: Iatrogenic Intestinal Ischaemiamentioning

confidence: 98%

Acute Mesenteric Ischaemia

Menon

Amin

Mohammed

et al. 2005

Acta Chirurgica Belgica

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“…Moore had first described this problem after abdominal aortic surgery in 1954 and has been confirmed by several retrospective and prospective reports [3,4,14,15]. Depending on the series, the risk for colon ischemia can range from 2 to 30% and once diagnosed, the mortality rate ranges from 50 to 90% [11].…”

Section: Discussionmentioning

confidence: 88%

“…When ischemic colitis was diagnosed, bowel resection with fecal diversion occurred in 65% with an overall mortality of 54 to 89% [3]. To prevent colon ischemia, the need for in line flow of the internal iliac arteries as well as preservation of the inferior mesenteric artery has been described [4].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Colon Mucosal Oxygen Saturation During Aortic Surgery

Lee

Bass

Arko

et al. 2006

Journal of Surgical Research

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“…Our operative mortality of 67% is comparable with reported results although a 45 rather than 30-day postoperative period and the inclusion of left colon infarctions in the study may have exaggerated our results. The fact that 22% of the patients had undergone a recent cardiac or vascular operation proves the importance of this factor: This particular group had already been identified (8,10,11,20) as being at risk of intestinal infarctions. Already known prognostic factors such as age over 75 years, the presence of shock, and the extent of infarction were confirmed in the univariate analysis.…”

Section: Discussionmentioning

confidence: 96%

“…Acute intestinal infarction results from inadequate blood flow through the superior mesenteric artery (SMA) and affects all or part of the small intestine and the right half of the colon (6). Occlusion of the inferior mesenteric artery (IMA) may lead to left colonic infarction, as after aortic surgery (2,8,11,15,20). Right and left colonic infarctions occur at the same time when both territories are involved, as may happen during cardiac operations (10).…”

Section: Introductionmentioning

confidence: 99%