Small bowel necrosis after aorto-iliac reconstruction

Abstract

Small bowel ischaemia causing necrosis is a rare complication after aorto-iliac reconstructive surgery. During a 14-year-period we have seen 6 cases out of 1343 reconstructions, making a frequency of 0.4 per cent. Diagnosis was difficult, causing a delay until re-exploration. Thrombocytopenia was a constant finding, and should raise suspicion. Pathogenesis was multifactorial. In two of our cases diagnosis was made at autopsy and in four at operation. Two patients survived extensive bowel resection but had a long stormy postoperative course.

Mesenteric Infarction after Aortoiliac Surgery on the Basis of 1752 Operations from the National Vascular Registry

“…Failing collateral flow may also be due to exceptional circulatory conditions in this area by reason, for example, of a prior resection of the colon or anomalies such as absent middle colic artery or incomplete marginal artery of Drummond [24]. Moreover, several authors have emphasized technical features, such as too distal ligature of the IMA with resultant compromising of collateral blood flow through its proximal branches [7,10,15], traction injury in the mesocolic vessels, or suprarenal aortic clamping with subsequent SMA embolization [2,4,5]. It should also be recognized that in patients who have a stenotic SMA the small bowel receives retrograde flow via the IMA [25].…”

“…Several retrospective studies have shown its occurrence to be 1% to 2% with an associated mortality of 40% to 100% [2][3][4][5][6][7][8][9][10][11]. The prospective studies in which postoperative sigmoidoscopy or colonoscopy has routinely been performed in all patients have revealed clinically mild and transient ischemic mucosal injuries to be present in up to 60% of patients after abdominal aortic reconstruction [12][13][14][15].…”

“…Intestinal infarction after reconstructive surgery of the abdominal aorta was mentioned for the first time by Moore in 1954 and has since been recognized as an infrequent but dramatic complication of this type of surgery [1]. Several retrospective studies have shown its occurrence to be 1% to 2% with an associated mortality of 40% to 100% [2][3][4][5][6][7][8][9][10][11]. The prospective studies in which postoperative sigmoidoscopy or colonoscopy has routinely been performed in all patients have revealed clinically mild and transient ischemic mucosal injuries to be present in up to 60% of patients after abdominal aortic reconstruction [12][13][14][15].…”

Nonocclusive Mesenteric Ischemia After Aorto-Iliac Reconstruction of a Ruptured Abdominal Aortic Aneurysm: Report of a Case

“…3 However, small bowel ischemia is a rare complication of such surgery, with an estimated incidence of only 0.15%-0.4%. 1,2 The pathogenesis of bowel ischemia after aortoiliac reconstruction is multifactorial. 2 NOMI has been defined as intestinal gangrene in the presence of a patent arterial tree.…”

“…1,2 This report describes a case of necrosis of the small intestine associated with nonocclusive mesenteric ischemia (NOMI) after aortoiliac reconstruction of a ruptured abdominal aortic aneurysm (AAA).…”