Pelvic radiation therapy as a risk factor for ischemic colitis complicating abdominal aortic reconstruction

Abstract

Ischemic colitis is an infrequent but potentially devastating complication of abdominal aortic reconstruction. Identification of patients with predisposing risk factors for the development of ischemic colitis can guide intraoperative measures to preserve or restore colonic blood flow during aortic surgery. Previous radiation therapy for pelvic malignancy may be one such predisposing risk factor. Two cases are presented in which ischemic colitis complicated abdominal aortic reconstruction in the setting of previous pelvic irradiation. In the months after radiation therapy for prostate cancer, one patient underwent infrarenal abdominal aortic aneurysm repair. Ischemic infarction of the sigmoid colon developed acutely after surgery and required emergent sigmoid colectomy. The second patient underwent reconstruction of an infrarenal abdominal aortic aneurysm after having had radiation therapy for a bladder tumor. Despite an initial satisfactory result, the patient's abdominal pain and diarrhea progressively worsened and he eventually required sigmoid colectomy for severe ischemic colitis. In both of these patients, the inferior mesenteric arteries were patent and had not been reimplanted. The association of pelvic radiation therapy with ischemic colitis after aortic reconstruction should focus attention to the operative details for maintaining the colonic circulation in these patients. Reimplantation of the inferior mesenteric artery in particular may prevent both the acute and the insidious variants of this complication in patients who undergo aortic surgery and decrease the incidence of this complication in patients with a history of radiation therapy to the pelvis.

Pelvic radiation therapy as a potential risk factor for ischemic colitis complicating abdominal aortic reconstruction

“…Given current knowledge and the increasing number of patients receiving pelvic radiotherapy, 11 , 12 we highlight the importance of considering this treatment as a factor for CI development. Interestingly, a similar statement was made 25 years ago in reporting of two cases 2 and highlighted in an editorial 13 in relation to a CI population-based analysis. 14 To our knowledge, no study has focused on such analysis during CI evaluation.…”

“…Although the recent literature suggests that endovascular aneurysm repair (EVAR) may be associated with a lower frequency of CI than open aortic repair (OAR), it remains unclear whether this is true. 1 Here, we describe an unusual case of CI clearly related to previous pelvic radiotherapy, which is reminiscent of a previous report published in this journal 25 years ago 2 with nearly the same title (here, we added the word potential to indicate that a direct cause and effect relationship should be evaluated). The patient has consented to publication of the details and images related to the case.…”

Insuficiencia Mesentérica Crónica Luego De Radioterapia Para Aórtica

“…no hay estudios prospectivos que analicen la incidencia de este daño en el territorio mesentérico pero hay descripciones de casos que destacan su importancia clínica. Es así como Israeli et al 13 , describieron dos pacientes que habían sido sometidos a radioterapia pelviana y sufrieron isquemia colónica aguda y severa luego de la reparación de aneurismas infrarrenales.…”

Anterior Communicating Artery Aneurysm Following Radiation Therapy for Optic Glioma: Report of a Case and Review of the Literature

“…The formation of aneurysms on various other arteries exposed to previous radiation therapy has been suggested. 8,[21][22][23] Intracranial aneurysm formation after radiotherapy is rare; only 21 patients have been reported (Table 1). [4][5][6][7][8][9][10][11][12][13][14][15][16][17]24 With the inclusion of our case, these patients include 12 males and 9 females (mean age, 39.85 years; range, 11 to 65).…”