ISCHEMIC COLITIS AFTER AORTIC-ANEURYSM OF ABDOMINAL AORTIC-ANEURYSM

Between 1978 and 1994, a total of 678 patients were operated on for in frarenal (abdominal) aortic aneurysm at the Department of Surgery of L ubeck Medical University. Rupture had occurred in 165 patients, 351 we re treated electively, and 162 presented with severe symptoms but no r upture. Only CT. angiography and intraoperative judgement were used fo r diagnosis. Reconstruction of the inferior mesenteric artery (IMA) wa s performed only in exceptional cases. Severe ischemic colitis occurre d in 1.03% (in no case following elective surgery, in 0.66% of patient s presenting with symptoms, and in 3.6% of patients in whom rupture ha d occurred prior to the operation). Three patients presented with mild ischemia, two with grade B ischemic colitis and three with transmural infarction. One patient had to be operated on for ischemic colitis de spite open reconstruction of the IMA. We conclude from our data that t here is no need to reconstruct the IMA as a routine procedure; this to pic has been a controversial issue in the literature. We do reimplant a patent IMA when there is only oozing from the IMA and/or a borderlin e perfusion of the sigma following the operation, with at least one op en internal iliac artery. When rupture has occurred, reconstruction sh ould be performed if there is the slightest suspicion because of the i ncreased risk, but only if the patient's cardiopulmonary condition all ows this to be done. Analysis of our patients with ischemic colitis de monstrates the importance of maintaining stable circulatory conditions to prevent intestinal ischemia. Further diagnostic procedures (Dopple r ultrasound, measuring of oxygen saturation or pH) may identify more patients at risk, but at the moment we do not consider these to be rou tine procedures.