FLEXIBLE SIGMOIDOSCOPY - A RELIABLE DETERMINANT OF COLONIC ISCHEMIA FOLLOWING RUPTURED ABDOMINAL AORTIC-ANEURYSM

Background: The development of colonic ischemia following repair of ru ptured abdominal aortic aneurysm (AAA) is associated with significant morbidity and timely diagnosis is essential. The purpose of this study was to determine the efficacy of endoscopy in the diagnosis of coloni c ischemia and in prediction of need for resection. Methods: Patients who underwent postoperative lower endoscopy after ruptured AAA from 19 86 to 1995 were reviewed for endoscopic findings, clinical course, and patient outcome. Results: A total of 80 patients had ruptured AAA dur ing the study period, of which 56 survived for longer than 24 h postop eratively, Flexible lower endoscopy was done in 18 patients (32%) on a n average of 4.4 days following AAA repair (range 1-16). Indications f or initial endoscopy included early or bloody stools in 12 (67%), hemo dynamic instability or sepsis in eight (44%), and acidosis in four (22 %), The extent of the examination was sigmoid or descending colon in 1 3, cecum in four, and transverse colon in one, Endoscopic findings wer e normal in four patients. Five examinations showed only areas of hemo rrhagic mucosa. Absence of full-thickness ischemia was confirmed by cl inical course or autopsy in these nine patients, Two examinations demo nstrated full-thickness necrosis which was confirmed at subsequent lap arotomy. In six examinations, ischemia was noted but judged to be limi ted to mucosa only. Absence of full-thickness disease was demonstrated by laparotomy in three and subsequent course in three. Eight patients (57%) with initial abnormal examinations underwent repeat endoscopy s howing improved interval appearance in seven cases and progression to full-thickness ischemia in one patient. Conclusions: Flexible sigmoido scopy reliably predicts full-thickness colonic ischemia following repa ir of ruptured aortic aneurysms. Patients with non-confluent ischemia limited to the mucosa can be safely followed by serial endoscopic exam inations.