Perioperative predictors of colonic ischemia after ruptured abdominal aortic aneurysm

Abstract

The results of this study show that: (1) colonic ischemia after rAAA may be predicted with the presence of two or more specific perioperative factors, (2) the lack of a guaiac-positive bowel movement may be misleading for the early diagnosis of colonic ischemia, and (3) more than 50% of the patients with colonic ischemia will require a colonic resection. We recommend that any patient with rAAA with more than two perioperative factors undergo sigmoidoscopy every 12 hours after surgery for 48 hours to rule out colonic ischemia without waiting for early or guaiac-positive bowel movement.

Risk factors for ischaemic colitis after surgery for abdominal aortic aneurysm: a systematic review and observational meta-analysis

“…(1.13-20.32)) were reported as risk factors in one study [20] . Pre-operative renal impairment was identified as a significant risk factor for development of ischaemic colitis in two papers, with reported odds ratios of 2.30 [14] and 4.67 [10] .…”

“…Dadian et al identified intra-operative hypotension of <70mmHg as associated with IC [19] . Three studies identified that massive transfusion was associated with increased rates of IC [19,20,15] . All of these were retrospective singlecentre observational studies.…”

Open abdomen treatment following endovascular repair of ruptured abdominal aortic aneurysms

“…Indication for surgical decompression was based on an IVP Ͼ20 mm Hg or abdominal perfusion pressure (systemic mean pressure minus intra-abdominal pressure) of Ͻ50 to 60 mm Hg and new development of organ dysfunction, or when patients fulfilled at least one of the criteria from the Table. 9,[15][16][17] The general algorithm of OAT for all RAAA patients in our institution is illustrated in Patients treated by eEVAR are at high risk for development of ACS; therefore, close monitoring of IVP and organ function is crucial to detect critical IAH. IVP measurement is initiated during EVAR and repeated every hour after the procedure.…”

Intestinal Ischemia and the Gut–Liver Axis: An in Vitro Model

“…Trauma victims suffer acute intestinal ischemia from direct mesenteric vessel injury or hemorrhagic shock [4 -6]. Surgical patients undergoing aortic or cardiac surgery involving bypass and/or aortic cross-clamping are shown to be at higher risk for intestinal ischemia complications postoperatively [7][8][9]. The mortality of patients with intestinal ischemia remains high, often due to the associated development of the systemic inflammatory response syndrome (SIRS) [10 -14].…”