Ischemic colitis following infrarenal abdominal aortic aneurysm treatment: Results from a tertiary medical center

Aday, Ulaş; Gündeş, Ebubekir; Çetin, Durmuş Ali; Çiyiltepe, Hüseyin; Senger, Aziz Serkan; Gülmez, Şelçuk; Akbulut, Mustafa; Polat, Erdal

doi:10.14744/nci.2017.80774

Cited by 4 publications

(10 citation statements)

References 16 publications

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“…Thrombophilia due to coagulopathy further increases the 28%-74% risk of ischemic colitis [ 15 ]. Recent research reveals the role of abdominal aortic aneurysm surgery in aggravating ischemic colitis and increasing its mortality rate [ 28 ]. The conditions, including paroxysmal nocturnal hemoglobinuria, protein S/C deficiency, polycythemia vera, and anti-thrombin deficiency, also increase the risk and incidence of ischemic colitis.…”

Section: Discussionmentioning

confidence: 99%

Lactulose-Induced Ischemic Colitis: A Rare Presentation and an Overview of Possible Etiologies of the Disease

Umar¹,

Ilyas²,

Shah³

et al. 2022

Cureus

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Ischemic colitis is one of the most common ischemic pathologies of the gastrointestinal system and can be divided into non-gangrenous and gangrenous forms. The pathophysiology involves restricted blood supply to the colonic mucosa. Several risk factors have been implicated in the development of ischemic colitis. Lactulose, one of the mainstay therapies for the treatment of hepatic encephalopathy in patients with cirrhosis, has been rarely reported as a cause of ischemic colitis. To the best of our knowledge, there has been only one case report associating lactulose use with the development of ischemic colitis. The exact pathophysiology is unknown but might be associated with the fermentation of lactulose by intestinal bacteria, causing gaseous distention and increasing the intraluminal pressure. We present the case of a 77-year-old African American male, a known case of non-alcoholic liver cirrhosis with portal hypertension and esophageal varices, brought in by his family to the emergency department for altered mental status, non-bilious vomiting, abdominal distension, and pain for one day. On physical examination, the patient had upper extremity asterixis and was alert but disoriented to place and person. Diagnostic paracentesis was performed, which revealed leukocytosis, predominantly neutrophils. The patient was admitted for spontaneous bacterial peritonitis and hepatic encephalopathy with decompensated liver cirrhosis. The patient was started lactulose with a goal of three to four bowel movements per day. Despite adequate treatment, the patient continued to develop worsening mental function and abdominal distension. This was later followed by a bloody bowel movement. Laboratory assessment showed an elevated white blood cell count, worsening kidney function, and high anion gap metabolic acidosis. CT scan revealed dilated loops of bowel with air and fluid along with submucosal wall edema, findings suggestive of ischemic colitis. Given the poor prognosis and the patient's condition, colonoscopy was deferred. Lactulose was discontinued, as it was thought to be a contributing cause of the patient's ischemic colitis. His condition continued to deteriorate, and he passed away on Day 18 of admission.

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Section: Discussionmentioning

confidence: 99%

Lactulose-Induced Ischemic Colitis: A Rare Presentation and an Overview of Possible Etiologies of the Disease

Umar¹,

Ilyas²,

Shah³

et al. 2022

Cureus

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“…The colonic resection was adapted to the IC extension, leading to a great majority of subtotal or total colectomies. Previous studies reported high mortality rates for IC developed after ruptured AAA repair surgery [15,16,20,26,40], with some differences related to the type of aortic surgery [14,22,40]. Indeed, a recent systematic review and metaanalysis demonstrated that IC occurs more frequently after open repair (2.1-3.6%) than in EVAR (0.5-1%) in the elective setting [22].…”

Section: Discussionmentioning

confidence: 99%

“…Older age, female gender, ruptured aneurysm, emergency surgery, prolonged surgery, aortic clamping duration, and previous cardiovascular history were associated with an increased risk of IC [5,15,17,20,21]. On the contrary, EVAR surgery was found to be protective towards IC compared to open aortic surgery probably due to lower ischemia-reperfusion injury and peripheral proinflammatory cytokine release [16,22,23].…”

Section: Introductionmentioning

confidence: 96%

“…IC occurring after aortic surgery has been reported to increase mortality by 50% [15]. Several studies investigated the risk factors of IC after abdominal aneurysm (AAA) repair and compared the occurrence of IC after endovascular aortic repair (EVAR) vs. open aneurysm repair [16][17][18][19]. Older age, female gender, ruptured aneurysm, emergency surgery, prolonged surgery, aortic clamping duration, and previous cardiovascular history were associated with an increased risk of IC [5,15,17,20,21].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience

et al. 2020

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Background: Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery. The aim of the present study was to identify the predictors of postoperative mortality after emergent open colectomy for IC treatment. Additionally, we compared postoperative outcomes of patients undergoing emergent colectomy due to aortic surgery-related IC (AS-IC group) vs. other IC etiologies (Other-IC group). Methods: We analyzed records of consecutive patients who underwent emergency open colectomy for IC between 2008 and 2019. Logistic regression analysis was performed to identify clinical and operative parameters associated with postoperative mortality. The AS-IC and Other-IC groups were compared for mortality, morbidity, ICU stay, hospital stay, and survival. Results: During the study period, 94 patients (mean age, 67.4 ± 13.7 years) underwent emergent open colectomy for IC. In the majority of cases, IC involved the entire colon (53.2%) and vasopressor agents were required preoperatively (63.8%) and/or intraoperatively (78.8%). Thirty-four patients underwent surgery due to AS-IC, whereas 60 due to Other-IC causes. In the AS-IC group, 9 patients had undergone endovascular aortic repair and 25 open aortic surgery; 61.8% of patients needed aortic surgery for ruptured abdominal aortic aneurism (AAA). Overall, 66 patients (70.2%) died within 90 days from surgery. The AS-IC and Other-IC groups showed similar operative outcomes and postoperative complication rates. However, the duration of the ICU stay (19 days vs. 11 days; p = 0.003) and of the total hospital stay (22 days vs. 16 days; p = 0.016) was significantly longer for the AS-IC group than for the Other-IC group. The rate of intestinal continuity restoration at 1 year after surgery was higher for the Other-IC group than for the AS-IC group (58.8% vs. 22.2%; p = 0.05). In the multivariate model, preoperative increased lactate levels, a delay between signs/symptoms' onset and surgery > 12 h, and the occurrence of postoperative acute kidney injury were statistically associated with postoperative mortality. Neither IC etiology (aortic surgery vs. other etiology) nor ruptured AAA was associated with postoperative mortality. Conclusion: Emergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology. Preoperative lactate levels, > 12-h delay to surgery, and postoperative acute kidney injury are independent predictors of postoperative mortality.

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“…Cross-clamping of the aorta, prolonged hypotension, microembolization, colonic trauma during open repair, and reperfusion injury are some of the possible etiologies for the presenting complication. Reduction in perfusion of the inferior mesenteric artery (IMA) can produce ischemia, most commonly on the splenic flexure and rectosigmoid junction due to frail anastomoses between the blood vessels [ 3 ]. Consequently, it can produce life-threatening sequela and contribute to prolonged length of intensive care unit (ICU) stays and accentuate healthcare costs.…”

Section: Introductionmentioning

confidence: 99%

Emphasis on Early Identification of Risk Factors to Curtail High Mortality Involved With Ischemic Colitis (IC) After Abdominal Aortic Aneurysm (AAA) Repair

Shrivastava¹,

Shrivastava²,

Avula³

et al. 2022

Cureus

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Ischemic colitis (IC) is one of the most feared complications after abdominal aortic aneurysm (AAA) repair. Though the complication is seen in only a handful of total repairs, the mortality rates after IC is very high. Due to infrequent presentation, attending doctors may overlook this possibility leading to a delay in diagnosis. Open repair and endovascular aneurysm repair (EVAR) are the two most common methods used for repairing aneurysms and both of these procedures have their implications in the development of IC. While the incidence of IC was greater after open repair, it also harbored more patients with ruptured aneurysms, emergency repairs, and patients in shock. Similarly, a significant proportion of patients having ruptured aneurysms developed IC. Controlling minor variables like acidosis, hypothermia, hypovolemia, and clamp time duration can play a cumulative role in diminishing this hazardous complication. Medical advancements and minimally invasive technologies have improved the quality of care and operation success considerably, but researchers have not identified a statistically significant association in the prevention of postoperative IC. Therefore, early diagnosis and prompt management become crucial in reducing mortality rates. This can be achieved by being aware of impending signs and symptoms especially in patients with risk factors and being proactive in medical management.

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Ischemic colitis following infrarenal abdominal aortic aneurysm treatment: Results from a tertiary medical center

Cited by 4 publications

References 16 publications

Lactulose-Induced Ischemic Colitis: A Rare Presentation and an Overview of Possible Etiologies of the Disease

Lactulose-Induced Ischemic Colitis: A Rare Presentation and an Overview of Possible Etiologies of the Disease

Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience

Emphasis on Early Identification of Risk Factors to Curtail High Mortality Involved With Ischemic Colitis (IC) After Abdominal Aortic Aneurysm (AAA) Repair

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