Cv. Soong et al., BOWEL ISCHEMIA AND ORGAN IMPAIRMENT IN ELECTIVE ABDOMINAL AORTIC-ANEURYSM REPAIR, British Journal of Surgery, 81(7), 1994, pp. 965-968
In 30 patients undergoing elective repair of abdominal aortic aneurysm
the intramucosal pH (pH(i)) of the sigmoid colon was measured. Blood
for endotoxin assay was taken at intervals before, during and after su
rgery. Daily measurements were made of liver transaminase activity and
of arterial partial pressure of oxygen (P-aO2). The mean(s.e.m.) peak
systemic endotoxin concentration in those who developed intramucosal
acidosis (pH(i) below 7.00) was 90(14) pg/ml, compared with 42(5) pg/m
l in those who did not (P < 0.01). In the 14 patients whose pH(i) fell
below 7.00, the mean(s.e.m.) postoperative rise in aspartate transami
nase activity was 346(74) per cent, compared with 181(20) per cent in
those whose pH(i) remained above this level (P < 0.05). The mean(s.e.m
.) postoperative ratio of P-aO2 to the fraction of inspired oxygen was
177(11) mmHg in those with intramucosal acidosis, compared with 260(2
4) mmHg in those whose pH(i) remained above 7.00 (P < 0.01). These res
ults demonstrate a relationship between bowel ischaemia, endotoxaemia
and organ impairment following elective aneurysm repair.