Colonic Infarction Research Articles

Ischemic Bowel Mimicking a Colonic Mass in RS3PE Syndrome

Remitting seronegative symmetrical synovitis with pitting edema syndrome is characterized by symmetrical synovitis involving wrists and flexor digitorum tendon sheaths associated with marked pitting edema of the dorsum of hands. It is considered a paraneoplastic syndrome. Here we describe a middle-aged patient with this syndrome presenting with acute abdomen and ischemic bowel mimicking a colonic mass. Rheumatologists and surgeons should consider mesenteric vascular events in patients with remitting seronegative symmetrical synovitis with pitting edema who present with acute abdomen, even in patients younger than 50 years. Our case is the first case in the literature reporting the association between ischemic infarction of colon and remitting seronegative symmetrical synovitis with pitting edema. Remitting seronegative symmetrical synovitis with pitting edema needs to be listed among other rheumatologic diseases associated with mesenteric vascular occlusion.

Colonic Infarction Following Open and Endovascular Abdominal Aortic Aneurysm Repair in Patients with Dolicosigma-2 Case Reports and Revision of Literature

Colonic Infarction Following Open and Endovascular Abdominal Aortic Aneurysm Repair in Patients with Dolicosigma-2 Case Reports and Revision of Literature. Colonic ischemia is a major adverse event after abdominal aortic aneurysm repair, both in open surgical or endovascular procedures, with poor prognosis and high mortality rates.

Iatrogenic embolization following cardiac intervention: postmortem analysis of 110 cases.

Iatrogenic embolization following cardiac investigative procedures may result from hydrophilic polymer emboli (HPE) from catheter valve and vessel wall calcifications, and air embolism from open heart surgery. This retrospective clinical pathologic analysis was undertaken to ascertain the frequency and extent of these potentially fatal complications. This retrospective clinical pathologic autopsy analysis with premortem diagnostic imaging correlation identified 110 individuals who had undergone endovascular procedures between 2010 and 2016 within 90 days of death and followed by hospital autopsy. Clinical outcomes, radiologic studies, and autopsy materials were reviewed. Iatrogenic emboli were assessed as causing death in 9/110 autopsy cases (8.2%) and 9/34 (26.5%) cases with proven iatrogenic emboli. Iatrogenic emboli caused strokes in 10/110 (9.1%) autopsy cases including calcified emboli (CE, n=6), HPE (n=2), cardiac valvular tissue (n=1), and air embolism (n=1). Seven cases of calcified emboli complicating endovascular procedures were identified: four of the CE were thought to be the cause of death due to fatal strokes (n=2) and fatal myocardial (n=1) and colonic infarction (n=1). The CE likely originated from calcified aortic valves and atherosclerotic aortic plaques. Histologic evidence of HPE was found in 23% (25/110) of cases; 54% (26/48) showed evidence of infarction in postprocedural imaging, with radiologic evidence of infarction in 32% (8/25) of cases with HPE histology. Endovascular aortic repair was associated with the greatest density/distribution of HPE. HPE material showed degradation with time and was often associated with an inflammatory response. HPE directly contributed to death in three cases. One fatal air embolism followed open heart surgery, and one cardiac tissue embolus resulted in a major stroke. We advocate for greater awareness of these underrecognized and occasionally fatal complications of endovascular procedures. Targeted postprocedural imaging has a role in the identification of iatrogenic embolic infarcts.

Vitamin D in Health and Disease – An Update

<p style="text-align: justify;">The importance of vitamin D in health and disease is being increasingly recognized nowadays and lots of research is being carried out in this area. Thus, it is essential to understand about this vitamin and this narrative review is one such initiative. The main aim of this review is to provide a comprehensive and in-depth knowledge of the role of vitamin D in health and disease. A comprehensive literature search was carried out in the search portals of PubMed, Google Scholar and Indmed to identify the role of vitamin D in health and disease. Vitamin D is a fat soluble prohormone, synthesized in our epidermal cells following exposure to sunlight. The synthesized precursors of vitamin D are metabolically activated by 25-hydroxylation in the liver and 1-&alpha; hydroxylation in the kidney. The biologically active form of vitamin D is 1, 25-dihydroxycholecalciferol which binds to the vitamin D receptor to mediate its effects. Vitamin D plays a key role in maintaining calcium and phosphate homeostasis in the body. However, vitamin D is also found to have various pleiotropic effects like anti-inflammatory, anti-apoptotic, antifibrotic and immunomodulatory effects. The serum 25-hydroxyvitamin D levels are considered as indicator of body&rsquo;s vitamin D stores. Deficiency of vitamin D is highly prevalent and is associated with various diseases like osteoporosis, hip fractures, myocardial infarction and malignancies of colon, breast and prostate.

Arterial reconstructions for pediatric splanchnic artery occlusive disease

ObjectivePediatric splanchnic arterial occlusive disease is uncommon and a rare cause of clinically relevant intestinal ischemia. This study was undertaken to better define the clinical manifestations and appropriate treatment of celiac artery (CA) and superior mesenteric artery (SMA) occlusive disease in children. MethodsClinical courses of 30 consecutive children undergoing operations for splanchnic arterial occlusive disease at the University of Michigan from 1992 to 2017 were retrospectively analyzed. ResultsVascular reconstructions were performed for splanchnic arterial disease in 18 boys and 12 girls, 1.5 to 16 years of age (mean, 7.5 ± 4.1 years). Isolated splanchnic arterial disease was uncommon (2 children), being more often associated with abdominal aortic coarctations (19 children) or ostial renal artery stenoses (25 children). Primary splanchnic arterial reconstructions (30) included aortic reimplantation of SMAs (15) or celiacomesenteric arteries (2), aortoceliac and aortomesenteric bypasses (7), reimplantation of the CA as a patch over the stenotic SMA orifice (3), and patch angioplasty of the CA (2) or SMA (1). There was no perioperative mortality. Two groups (I and II) were identified for study. Group I children (14) experienced symptomatic intestinal ischemia, manifested by various combinations of chronic postprandial abdominal discomfort (14), ischemia-related intestinal bleeding (2), or failure to thrive (4). Four children in group I became symptomatic after known CA and SMA occlusive disease was left untreated at the time they underwent earlier interventions for renovascular hypertension. Seven secondary redo interventions were undertaken for recurrent symptoms in six group I children. Only one major periprocedural complication occurred: segmental colon infarction. The assisted patency rate of reconstructed arteries in group I children was 93%, and intestinal ischemic symptoms resolved in every child. Group I follow-up from the most recent splanchnic arterial reconstruction averaged 4.3 years. Group II children (16) without manifestations of intestinal ischemia underwent prophylactic splanchnic arterial reconstructions in concert with combined aortic and renal artery procedures (11), isolated abdominal aortic reconstructions (3), or renal artery reconstructions alone (2). Group II children experienced no major perioperative morbidity and remained asymptomatic postoperatively, and none required secondary splanchnic artery interventions. Group II follow-up averaged 7.4 years. ConclusionsPediatric splanchnic artery occlusive lesions are often associated with developmental aortic and renal artery occlusive disease. Carefully conducted therapeutic and prophylactic reconstructive procedures are appropriate in children having splanchnic arterial occlusive disease.

RGD delivery of truncated coagulase to tumor vasculature affords local thrombotic activity to induce infarction of tumors in mice

Induction of thrombosis in tumor vasculature represents an appealing strategy for combating cancer. Herein, we combined unique intrinsic coagulation properties of staphylocoagulase with new acquired functional potentials introduced by genetic engineering, to generate a novel bi-functional fusion protein consisting of truncated coagulase (tCoa) bearing an RGD motif on its C-terminus for cancer therapy. We demonstrated that free coagulase failed to elicit any significant thrombotic activity. Conversely, RGD delivery of coagulase retained coagulase activity and afforded favorable interaction of fusion proteins with prothrombin and αvβ3 endothelial cell receptors, as verified by in silico, in vitro, and in vivo experiments. Although free coagulase elicited robust coagulase activity in vitro, only targeted coagulase (tCoa-RGD) was capable of producing extensive thrombosis, and subsequent infarction and massive necrosis of CT26 mouse colon, 4T1 mouse mammary and SKOV3 human ovarian tumors in mice. Additionally, systemic injections of lower doses of tCoa-RGD produced striking tumor growth inhibition of CT26, 4T1 and SKOV3 solid tumors in animals. Altogether, the nontoxic nature, unique shortcut mechanism, minimal effective dose, wide therapeutic window, efficient induction of thrombosis, local effects and susceptibility of human blood to coagulase suggest tCoa-RGD fusion proteins as a novel and promising anticancer therapy for human trials.

Diagnostic Dilemma in the Treatment of a Fatal Case of Bloody Diarrhea.

Although diarrhea is the most commonly reported pediatric illness in the United States, mortality is usually a rare and unexpected event. We report the case of a healthy 13-month-old male that succumbed to a diarrheal illness of unclear etiology. Presenting signs included frequent nonbloody stools that progressed to frankly bloody stools over 72 hours. Associated symptoms included fever, tenesmus, relief with stool passage, and significant fatigue. On examination, the patient appeared tired and lay with legs curled toward his chest. The abdominal exam was remarkable for hypoactive bowel sounds, diffuse tenderness to palpation without guarding or rebound pain, and intermittent prolapse of rectal tissue. Abdominal plain films demonstrated a paucity of bowel gas, especially in the rectum; and ultrasound revealed thickening of bowel loops in the left lower quadrant. Abdominal computed tomography scan showed decreased enhancement of the mucosa of the rectosigmoid colon. The patient deteriorated rapidly with cardiorespiratory arrest occurring 48 hours after admission. Despite a protracted effort at cardiopulmonary resuscitation, perfusing heart rate or rhythm could not be reestablished. Autopsy revealed infarction and necrosis of the rectosigmoid colon with invasive gram-negative bacilli. Here we present his perplexing case, diagnostic evaluations, and suggest a unifying diagnosis.

Long-term outcome and quality of life after supercharged jejunal interposition for oesophageal replacement

BackgroundThe consequences of major conduit necrosis following oesophagectomy are devastating. Jejunal interposition with vascular supercharging is an alternative reconstructive method if colon is unavailable. Aims of this study were to review the long-term outcome and quality of life of patients undergoing this surgery in our tertiary unit. MethodsPatients undergoing oesophageal reconstruction with supercharged jejunum were identified and retrospective review of hospital notes performed. Each patient was then interviewed for follow up data and quality of life assessment using the EORTC QLQ-C30 questionnaire. ResultsSix patients (5 men) (median age 59 years (range 34–72) underwent supercharged pedicled jejunal (SPJ) interposition from May 2005–August 2010. Indications for surgery were loss of both gastric and colonic conduits following surgery for oesophageal cancer (n = 4), loss of gastric conduit and previous colectomy (n = 1) and lastly, gastric and colonic infarction in a strangulated paraoesophageal hernia (n = 1). Median time to reconstruction was 12 months [6–15 range]. There were no in-hospital deaths. Median postoperative stay was 46 days [13–118]. Three patients required surgical re-intervention for leak, sepsis and reflux, respectively. Median follow up was 6.5 years [range 7–102 months]. One patient died seven months following surgery due to respiratory complications. On follow up, 5 patients have an enteral diet without supplemental nutrition, maintaining weight and good quality of life scores. ConclusionsSupercharged jejunal interposition is a suitable alternative conduit for delayed oesophageal replacement in patients with otherwise limited reconstructive options. Good functional outcomes can be achieved despite formidable technical challenges in this group.

Reply to Letter re: Non-target Embolization or Local Effect of Infarction?

Dear Sir, We thank the authors for their interest in our case report. The cause of perforation of transverse colon 3 months after uterine artery embolization cannot be established for certain, but the fact that the perforated colon is stuck down to the large necrotic fundal fibroid suggest that direct, local inflammatory involvement is likely. Smallor large-bowel injury from uterine artery embolization is surprisingly rare even for large fibroid uterus but a few cases have been reported previously [1, 2]. We maintain that the risk of such complication is higher if a large serosal fibroid on the fundus of uterus is present, as in this case. If there is colonic infarction at the time of uterine artery embolization, it is not clear why the patient would have bowel perforation 3 months later, when there is a relative absence of symptoms of ischaemic bowel injury in the interim. Finally, we are not advocating early laparotomy for all cases but where there is sufficient clinical concern and risk factors for bowel injury are present, even if imaging is normal, the risks of laparotomy may be outweighed by the benefits. As in the present case, where irrespective of the mechanism of large bowel injury, there seems to be no other way of treating such a catastrophic complication.

Ischemic Necrosis of the Sigmoid Colon after Antegrade Sclerotherapy of Idiopathic Varicocele: A Case Report

A 34-year-old man affected by grade IV idiopathic varicocele with mild testicolar pain, severe oligoasthenozoospermia and infertility, underwent an antegrade sclerotherapy according to Tauber surgical technique. After 5 days, the patient underwent a laparoscopic left colon resection with colonstomy due to a segmental infarction of the sigmoid colon.

Report of a case of ischemic colitis with bilaterally patent internal iliac arteries after endovascular abdominal aneurysm repair

During endovascular aneurysm repair (EVAR), interruption of the internal iliac arteries (IIAs) or the inferior mesenteric artery by stents or embolization is thought to cause colon ischemia. To minimize this risk, attempts have been made to preserve the IIAs using iliac branch devices or IIA revascularization. Here we present our experience of colon ischemia after EVAR in a patient with bilaterally patent IIAs without evidence of embolism. A 70-year-old man had abdominal pain and a ruptured abdominal aortic aneurysm was found. We performed EVAR with custom-made tube grafts preserving the bilateral IIAs. On postoperative day 2, the patient complained of abdominal pain, a sigmoidoscopy was performed revealing colon ischemia. On laparotomy, transmural infarction of the sigmoid colon was found and resected. Because IIA preservation cannot guarantee protection against colon ischemia, surgeons should maintain a high level of suspicion and use surveillance liberally after EVAR for early diagnosis of colon ischemia, even if both IIAs are preserved.

Isolated ileocolic artery occlusion presented with segmental bowel infarction: a case report.

Acute mesenteric ischemia is a serious acute abdominal condition requiring early diagnosis and intervention to improve the outcome. Although transmural acute bowel infarction represents about 1% of all cases of acute abdomen, it has a higher annual mortality rate than colon cancer. It tends to affect the colon in segmental fashion, mostly the splenic flexure and rectosigmoid portions of the colon. Isolated ischemia of the right side of the colon is rarely reported, especially in association with shock. Diagnosis of acute colonics ischemia is challenging as it may easily be confused with other non ischemic conditions both clinically and radiologically. Surgical resection is still the main curative approach. We present a case of segmental terminal ileum, cecum and part of ascending colon infarction due to isolated IleoColic artery thrombosis.

The Management of Multi-Site, Bleeding, Visceral Artery Pseudoaneurysms, Secondary to Necrotising Pancreatitis

We present the case of a 45-year-old man, who presented to his local casualty department with severe epigastric pain following an alcohol binge, and was subsequently diagnosed with acute pancreatitis. Pancreatic necrosis with multiple collections ensued, necessitating transfer to an intensive care unit (ITU) in a tertiary hepatopancreaticobiliary centre. Initially, the patient appeared to slowly improve and was discharged to the ward, albeit following a prolonged ITU admission. However, during his subsequent recovery, he suffered multiple episodes of haematemesis and melaena associated with haemodynamic instability and requiring repeat admission to the ITU. Computerised tomographic angiography, followed by visceral angiography, was used to confirm the diagnosis of multisite visceral artery pseudoaneurysms, secondary to severe, necrotising pancreatitis. Pseudoaneurysms of the splenic, left colic and gastroduodenal arteries were sequentially, and successfully, radiologically embolised over a period of 9 days. Subsequent sequelae of radiological embolisation included a clinically insignificant splenic infarct, and a left colonic infarction associated with subsequent enterocutaneous fistula formation. The patient made a prolonged, but successful, recovery and was discharged from hospital after 260 days as an in-patient. This case illustrates the rare complication of three separate pseudoaneurysms, secondary to acute pancreatitis, successfully managed radiologically in the same patient. This case also highlights the necessity for multidisciplinary involvement in the management of pseudoaneurysms, an approach that is often most successfully achieved in a tertiary setting.

Two Cases of Colonic Obstruction after Acute Pancreatitis

Several forms of colonic complications are rarely observed during the clinical course of acute pancreatitis, and potentially fatal in some cases. Colonic lesions associated with acute pancreatitis can be divided into several groups from a pathogenic point of view. Possible pathogenesis includes: 1) spread of pancreatic enzymes through the retroperitoneum to mesocolon, causing pericolitis, 2) external inflammatory compression by mesocolic mass secondary to necrosis of fatty tissue, and 3) hypotension due to shock, and thrombosis of mesenteric arteries. These might lead to colonic infarction, fistula formation, perforation, and obstruction during follow-up. We report two cases of colonic obstruction following acute pancreatitis with possible different mechanisms and review Korean cases. One patient developed colonic obstruction due to severe necrotizing pancreatitis, possibly as a result of pericolitis, and the other developed stenosis as a result of ischemic colitis induced by acute pancreatitis.

Efficacy of transarterial embolization as definitive treatment in lower gastrointestinal bleeding

Transarterial catheter embolization (TAE) is integral in the management of lower gastrointestinal bleeding (BLGIT). The efficacy of superselective embolization has reduced the need for emergent surgical resection as a treatment modality. To determine the outcomes of TAE in the management of BLGIT in terms of efficacy rates, recurrent bleeding rates and long term results without the need for surgical intervention. Patients who underwent TAE for BLGIT between September 2000 and May 2006 were analysed. Data were extracted from the records for analysis. Sixty-eight patients with a mean age of 76 years and equal gender distribution were analysed. Sixty-nine per cent presented with haematochezia, 40% with malena. Sixty-three patients had a prior RBC scan performed, all of which were positive. Colonoscopy was attempted in 18 patients of which four managed to localize the bleeding site. Embolization was performed in these patients using mainly polyvinyl alcohol particles and/or microcoils. The morbidity rate was 21%, comprising mainly fever and nonspecific abdominal pain with only four ischaemic complications and one report of colonic infarction. Early recurrent bleeding occurred in six patients. Three were treated with repeat embolization and two required surgery. There were no mortalities. After a mean follow-up of 12 months, 12 (17.6%) patients developed further episodes of BLGIT, necessitating further intervention. Transarterial catheter embolization is effective and safe in the acute management of BLGIT and reduces the need for further definitive surgery in a majority of patients.

Transmural Colonic Infarction Associated with Hyperoxaluria

Purpose: We describe a 42-year-old woman with a history of kidney stones secondary to hyperoxaluria who was admitted with presumed infectious diarrhea. Colonoscopy was consistent with ischemic colitis. She then proceeded to have peritoneal signs needing laparotomy and was noted to have transmural ischemia of the right colon. Methods: A previously healthy 42-year-old woman developed acute lower abdominal pain 6 hours after eating at a buffet lunch. She then had bloody diarrhea overnight and was admitted. She had a long history of kidney stones & had been diagnosed with hyperoxaluria in childhood. She denied prolonged vomiting, dehydration or decreased urine output. Physical exam was notable for bilateral lower quadrant tenderness and mild fever. White blood cell count was normal. The initial working diagnosis was infectious diarrhea and she was conservatively managed. However, her lower quadrant abdominal pain persisted and a CT scan of the abdomen was performed. This showed diffuse bowel wall thickening of the right colon extending to the splenic flexure. Subsequently colonoscopy was performed. It showed patchy areas of erythema, superficial hemorrhages, small erosions & edema of the mucosa in the watershed areas in the right colon with rectal sparing, consistent with ischemic colitis. Later that night, she continued to worsen and developed peritoneal signs. She underwent emergent exploratory laparotomy. Intraop, the cecum, right colon & transverse colon were severely edematous & dilated. There was a gelatinous look to the mesentery. A right hemicolectomy was performed. Pathology was consistent with transmural infarction. Results: Hyperoxaluria is a genetic disorder characterized by calcium oxalate nephrolithiasis often with extrarenal oxalate deposition. Ischemic complications can occur because of crystal deposition in vessel walls. These manifest usually as peripheral limb or cutaneous ischemia. Rare reported cases of fatal intestinal infarction have been described. In this situation, a 42 year old woman with systemic oxalosis developed abdominal symptoms initially thought to infectious in origin and then turned out to have extensive infarction of the right colon. Conclusion: Hyperoxaluria is associated with systemic crystal deposition in the vasculature. Rare case reports of intestinal infarction have been described secondary to microvascular crystal disease. Therefore even in younger patients with no other risk factors, one should always consider ischemic colitis in the differential diagnosis of an acute abdomen in Hyperoxaluria.

Acute Lower Gastrointestinal Hemorrhage: Minimally Invasive Management with Microcatheter Embolization

To evaluate the efficacy of superselective embolization therapy in the management of acute lower gastrointestinal (LGI) hemorrhage, including any bleeding distal to the ligament of Treitz. Between June and August 2007, 20 patients with acute LGI bleeding underwent superselective transcatheter arterial embolization (TAE) at the authors' institution. The bleeding had different causes. All patients were treated with use of microcatheters. The following embolic agents were used: microcoils (n = 16), polyvinyl alcohol (PVA) particles (n = 2), and a combination of microcoils and PVA particles (n = 2). Outcome measures included technical success (complete cessation of bleeding as documented at completion angiography), clinical success (resolution of signs or symptoms of LGI bleeding within 30 days after TAE), and the rate of major and minor complications. The identified bleeding sources were as follows: jejunal branch, branch of middle colic artery, branch of ileocolic artery, ileal branch, branch of left colic artery, branch of sigmoid artery, branch of the superior rectal artery, and branch of the middle rectal artery. Technical success with effective control of active bleeding was achieved in all patients (100%). Clinical success attributed to TAE was documented in 18 of the 20 patients (90%). Major complications included death due to pulmonary embolism, heart infarction, and multiorgan failure in the 3rd week after TAE; a procedure-related colonic infarction occurred in one patient. A minor complication occurred in one patient who developed a groin hematoma. Superselective embolization may be used for effective, minimally invasive control of acute LGI bleeding.

Isolated iliac artery aneurysms: A contemporary comparison of endovascular and open repair

Iliac artery aneurysms are rare but associated with significant morbidity and mortality when ruptured. This study compares recent open and endovascular repairs of iliac aneurysms at a single institution. Patients were identified and charts reviewed using ICD-9 and CPT codes for iliac artery aneurysm and open or endovascular repair performed between January 2000 and January 2006. Baseline characteristics, procedure-related variables, and follow-up data were retrospectively reviewed. A total of 71 patients were treated with isolated iliac artery aneurysms. There were 19 open and 52 endovascular repairs. Seven presented with acute ruptures and were treated by open (4) or endovascular (3) repair. Preoperative comorbidities were similar between the two groups. Major perioperative (30 day) complications included three deaths in the open group from cardiovascular complications, all after ruptured aneurysm repair, and one death in the endovascular group (after rupture; one additional perioperative death occurred after 30 days due to colonic infarction) (P = NS). Postoperative complications were less frequent in the endovascular group, although this did not reach statistical significance. The mortality was 50% in the open group and 33% in the endovascular group for patients presenting with a ruptured aneurysm (P = NS). Transfusion requirement was significantly higher in the open group (47%) than in the endovascular group (6%) (P = .03). The mean follow-up was 20 +/- 5 months in the open group and 17 +/- 2 months in the endovascular group (P = NS). Long-term complications included two limb thromboses following repair with a bifurcated stent graft that were treated with thrombolysis plus stenting or a fem-fem bypass. Three endoleaks were identified on postop CT scans, all of which were successfully managed with endovascular techniques. There were no postoperative ruptures or aneurysm-related death. The mean postoperative length of stay was 5.2 +/- 2.3 days (open) and 1.3 +/- 1.0 days (endovascular) (P = .04). This is the first large, case control study comparing open vs endovascular repair of isolated iliac artery aneurysms. Endovascular repair of iliac artery aneurysms is safe and results in decreased length of stay, lower requirement for perioperative blood transfusion, and similar intermediate term outcomes as open repair.

Abdominal aortic aneurysm repair and colonic infarction: a risk factor appraisal

Colonic infarction is a recognized complication of abdominal aortic aneurysm (AAA) surgery. The clinical difficulty in establishing the diagnosis combined with the patient's poor physiological status is usually associated with a fatal outcome. We assessed our experience with this problem to identify a possible risk factor profile for these patients. Patients records were identified from the operative logs, intensive care unit, Hospital Inpatient Enquiry system and vascular unit databases over a 6-year period. A total of 405 patients underwent AAA repair during this period; 140 as emergency ruptures. Nine patients were identified from the databases with known colonic infarction (2.2%). One was a woman. The mean age was 70 years. Seven patients had emergency ruptures (5%). Twenty independent risk factors were analysed using univariate and multivariate logistic regression models. Significant risk factors identified by using a multivariate analysis included the nature of the presenting patient, preoperative hypotension, prolonged cross-clamp time, intra-operative ischaemia and postoperative acidosis. Confirmatory diagnosis was made by colonoscopy in eight patients. One patient survived following the salvage surgery. The mean duration of survival was 10.5 days. The overall mortality was 89% of patients. In our unit infrarenal AAA repair has a 2.2% rate of colonic infarction. A definitive diagnosis is best made by colonoscopy. A risk factor profile for the development of colonic infarction may be constructed on the basis of specific clinical parameters. Earlier intervention on the basis of this profile may ultimately reduce the current excessive mortality.

Intraoperative Colon Mucosal Oxygen Saturation During Aortic Surgery

Colonic ischemia after aortic reconstruction is a devastating complication with high mortality rates. This study evaluates whether Colon Mucosal Oxygen Saturation (CMOS) correlates with colon ischemia during aortic surgery. Aortic reconstruction was performed in 25 patients, using a spectrophotometer probe that was inserted in each patient's rectum before the surgical procedure. Continuous CMOS, buccal mucosal oxygen saturation, systemic mean arterial pressure, heart rate, pulse oximetry, and pivotal intra-operative events were collected. Endovascular aneurysm repair (EVAR) was performed in 20 and open repair in 5 patients with a mean age of 75 +/- 10 (+/-SE) years. CMOS reliably decreased in EVAR from a baseline of 56% +/- 8% to 26 +/- 17% (P < 0.0001) during infrarenal aortic balloon occlusion and femoral arterial sheath placement. CMOS similarly decreased during open repair from 56% +/- 9% to 15 +/- 19% (P < 0.0001) when the infrarenal aorta and iliac arteries were clamped. When aortic circulation was restored in both EVAR and open surgery, CMOS returned to baseline values 56.5 +/- 10% (P = 0.81). Mean recovery time in CMOS after an aortic intervention was 6.4 +/- 3.3 min. Simultaneous buccal mucosal oxygen saturation was stable (82% +/- 6%) during aortic manipulation but would fall significantly during active bleeding. There were no device related CMOS measurement complications. Intra-operative CMOS is a sensitive measure of colon ischemia where intraoperative events correlated well with changes in mucosal oxygen saturation. Transient changes demonstrate no problem. However, persistently low CMOS suggests colon ischemia, thus providing an opportunity to revascularize the inferior mesenteric artery or hypogastric arteries to prevent colon infarction.