Necrosis of the Colon Following Elective Resection of Abdominal Aortic Aneurysms

Abstract

Ischemic gangrene of the colon is a severe complication of abdominal aortic surgery. It has been noted in 0.5 to 2.0% of' the series.'-3 Early recognition of this complication is therefore of the utmost importance to the vascular surgeon since the mortality rate following gangrene of the left colon is very high, f'rom 50 to 90% of the patients. 1. 2, 4, 5 The syndrome is also of interest since it represents a model of acute devascularization of the left colon in the human by deliberate ligation of the inferior mesenteric artery.The severity of the clinical picture depends upon the depth of involvement of the intestinal wall and the symptomatology accompanying this complication is neither obvious nor typical.A case of extensive gangrene of the left colon following the resection of an abdominal aortic aneurysm is hereby presented. The patient survived the complication in spite of the delay in diagnosis. The experience of other authors is reviewed and the clinical signs of' this complication and especially the heralding ones are emphasized. Preventive measures are given consideration. CASE REPORTA 58-year-old patient presented with a pulsating mass in the abdomen. The patient had been complaining of vague epigastric discomfort for the last month. He had been treated for hypertension for the last four years and had suffered an inferior wall myocardial infarction thirteen years previously.On admission, the patient was in good general condition. The blood pressure was 220/120 mm. Hg. The pulse was regular, 72/min. The first heart sound was pronounced over the apex and the second heart sound over the base. A faint systolic murmur was heard over the heart. A pulsating mass, 10 cms. in diameter was felt on palpation in the mid-abdomen. Systolic murmurs were heard over both carotid and femoral arteries. A first degree hypertensive retinopathy was also present.The plain abdominal X-ray film showed a calcified rim lateral to the lumbar spine. The chest roentgenogram showed enlargement of the heart and of' the ascending aorta. The E.C.G. confirmed the diagnosis of old inferior wall myocardial infarction with the left ventricular hypertrophy and strain. All other laboratory examinations were within normal limits.At operation, an infra-renal, heavily calcified and firmly adherent aneuat NORTH DAKOTA STATE UNIV LIB on May 30, 2015 ves.sagepub.com Downloaded from