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Complications of Abdominal Aortic Surgery: Part II: Intestinal Ischemia

Complications of Abdominal Aortic Surgery: Part II: Intestinal Ischemia Abstract Intestinal ischemia is an uncommon but often serious complication of reconstructive surgery of the abdominal aorta. The degree of ischemia may be mild, producing days or weeks of diarrhea and abdominal distention, yet reversible, and ultimately ending in recovery of the patient. Ischemia may be more severe, producing chronic ulceration that, when healed, may result in the formation of a stricture. Severe ischemia may lead to gangrene of the bowel, perforation, and peritonitis. The occurrence of intestinal ischemia has been reported in almost every large series of patients who have undergone abdominal aortic surgery. We have recognized this complication in 8 of 800 patients after abdominal aortic surgery; 6 of the 8 patients died. A review of the literature yielded 34 other cases with 17 deaths. Table 1 summarizes the data concerning the 42 patients. Clinical Data The series of 42 reported patients is comprised of 4 women and 38 References 1. Barnes, W. H.; Ellis, F. H., Jr.; Kirlin, J. W., and Edwards, J. E.: Experiences with 165 Aortic Homografts , Surg. Gynec. Obstet. 106:49-55 ( (Jan.) ) 1958. 2. Bernatz, P. E.: Necrosis of the Colon Following Resection for Abdominal Aortic Aneurysms , Arch. Surg. 81:373-378 ( (Sept.) ) 1960.Crossref 3. Cannon, J. A.: in discussion of Payne, J. H., et al.: Amer. J. Surg. 90:314-316 ( (Aug.) ) 1955.Crossref 4. Case Records of the Massachusetts General Hospital: Case 7-1962 , New Engl. J. Med. 266:196-201 ( (Jan. 25) ) 1962.Crossref 5. Demos, N. J.; Bahuth, J. J., and Urnes, P. D.: Comparative Study of Arteriosclerosis in the Inferior and Superior Mesenteric Arteries: With a Case Report of Gangrene of the Colon , Ann. Surg. 155:599-605 ( (April) ) 1962.Crossref 6. Goldman, L., in Discussion of Carter, R.; Vannix, R.; Hinshaw, D. B., and Stafford, C. E.: Acute Inferior Mesenteric Vascular Occlusion: A Surgical Syndrome , Amer. J. Surg. 98:271-275 ( (Aug.) ) 1959.Crossref 7. Gwathmey, O.; Pierpont, H. C., and Blades, B.: Clinical Experiences with the Surgical Treatment of Acquired Aortic Vascular Disease , Surg. Gynec. Obstet. 107:205-213 ( (Aug.) ) 1958. 8. MacVaugh, H., III, and Roberts, B.: Results of Resection of Abdominal Aortic Aneurysm , Surg. Gynec. Obstet. 113:17-23, ( (July) ) 1961. 9. McKain, J., and Shumacker H. B., Jr.: Ischemia of the Left Colon Associated with Abdominal Aortic Aneurysms and Their Treatments , A.M.A. Arch. Surg. 76:355-357 ( (March) ) 1958.Crossref 10. Moore, S. W.: Resection of the Abdominal Aorta with Defect Replaced by Homologous Graft , Surg. Gynec. Obstet. 99:745-755 ( (Dec.) ) 1954. 11. Movius, H. J., II: Resection of Abdominal Arteriosclerotic Aneurysm , Amer. J. Surg. 90:298-305, 1955.Crossref 12. Morton, J. H.; Furth, F. W.; Hinshaw, J. R., and Schilling, J. A.: The Use of Aureomycin in Experimental Intestinal Obstruction , Ann. Surg. 134:1007-1012 ( (Dec.) ) 1951.Crossref 13. Ochsner, J. L.; Cooley, D. A., and DeBakey, M. E.: Associated Intra-Abdominal Lesions Encountered During Resection of Aortic Aneurysms: Surgical Consideration , Dis. Colon Rectum 3:485-490 ( (Nov.-Dec.) ) 1960.Crossref 14. Poth, E. J., and McClure, J. N., Jr.: Intestinal Obstruction; the Protective Action of Sulfasuxidine and Sulfathalidine to the Ileum Following Vascular Damage , Ann. Surg. 131:159-170 ( (Feb.) ) 1950.Crossref 15. Sarnoff, S. J., and Fine, J.: The Effect of Chemotherapy on the Ileum Subjected to Vascular Injury , Ann. Surg. 121:74-82 ( (Jan.) ) 1945.Crossref 16. Sheranian, L. O.; Edwards, J. E., and Kirklin, J. W.: Late Results in 110 Patients with Abdominal Aortic Aneurysm Treated by Resectional Placement of Aortic Homograft , Surg. Gynec. Obstet. 109:309-314 ( (Sept.) ) 1959. 17. Smith, R. F., and Szilagyi, D. E.: Ischemia of the Colon as a Complication in the Surgery of the Abdominal Aorta , A.M.A. Arch. Surg. 80:806-820 ( (May) ) 1960.Crossref 18. Young, J. R.; Britton, R. C.; deWolfe, V. G., and Humphries, A. W.: Intestinal Ischemic Necrosis Following Abdominal Aortic Surgery, Surg. Gynec. Obstet., to be published. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Complications of Abdominal Aortic Surgery: Part II: Intestinal Ischemia

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Publisher
American Medical Association
Copyright
Copyright © 1963 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1963.01310070053007
Publisher site
See Article on Publisher Site

Abstract

Abstract Intestinal ischemia is an uncommon but often serious complication of reconstructive surgery of the abdominal aorta. The degree of ischemia may be mild, producing days or weeks of diarrhea and abdominal distention, yet reversible, and ultimately ending in recovery of the patient. Ischemia may be more severe, producing chronic ulceration that, when healed, may result in the formation of a stricture. Severe ischemia may lead to gangrene of the bowel, perforation, and peritonitis. The occurrence of intestinal ischemia has been reported in almost every large series of patients who have undergone abdominal aortic surgery. We have recognized this complication in 8 of 800 patients after abdominal aortic surgery; 6 of the 8 patients died. A review of the literature yielded 34 other cases with 17 deaths. Table 1 summarizes the data concerning the 42 patients. Clinical Data The series of 42 reported patients is comprised of 4 women and 38 References 1. Barnes, W. H.; Ellis, F. H., Jr.; Kirlin, J. W., and Edwards, J. E.: Experiences with 165 Aortic Homografts , Surg. Gynec. Obstet. 106:49-55 ( (Jan.) ) 1958. 2. Bernatz, P. E.: Necrosis of the Colon Following Resection for Abdominal Aortic Aneurysms , Arch. Surg. 81:373-378 ( (Sept.) ) 1960.Crossref 3. Cannon, J. A.: in discussion of Payne, J. H., et al.: Amer. J. Surg. 90:314-316 ( (Aug.) ) 1955.Crossref 4. Case Records of the Massachusetts General Hospital: Case 7-1962 , New Engl. J. Med. 266:196-201 ( (Jan. 25) ) 1962.Crossref 5. Demos, N. J.; Bahuth, J. J., and Urnes, P. D.: Comparative Study of Arteriosclerosis in the Inferior and Superior Mesenteric Arteries: With a Case Report of Gangrene of the Colon , Ann. Surg. 155:599-605 ( (April) ) 1962.Crossref 6. Goldman, L., in Discussion of Carter, R.; Vannix, R.; Hinshaw, D. B., and Stafford, C. E.: Acute Inferior Mesenteric Vascular Occlusion: A Surgical Syndrome , Amer. J. Surg. 98:271-275 ( (Aug.) ) 1959.Crossref 7. Gwathmey, O.; Pierpont, H. C., and Blades, B.: Clinical Experiences with the Surgical Treatment of Acquired Aortic Vascular Disease , Surg. Gynec. Obstet. 107:205-213 ( (Aug.) ) 1958. 8. MacVaugh, H., III, and Roberts, B.: Results of Resection of Abdominal Aortic Aneurysm , Surg. Gynec. Obstet. 113:17-23, ( (July) ) 1961. 9. McKain, J., and Shumacker H. B., Jr.: Ischemia of the Left Colon Associated with Abdominal Aortic Aneurysms and Their Treatments , A.M.A. Arch. Surg. 76:355-357 ( (March) ) 1958.Crossref 10. Moore, S. W.: Resection of the Abdominal Aorta with Defect Replaced by Homologous Graft , Surg. Gynec. Obstet. 99:745-755 ( (Dec.) ) 1954. 11. Movius, H. J., II: Resection of Abdominal Arteriosclerotic Aneurysm , Amer. J. Surg. 90:298-305, 1955.Crossref 12. Morton, J. H.; Furth, F. W.; Hinshaw, J. R., and Schilling, J. A.: The Use of Aureomycin in Experimental Intestinal Obstruction , Ann. Surg. 134:1007-1012 ( (Dec.) ) 1951.Crossref 13. Ochsner, J. L.; Cooley, D. A., and DeBakey, M. E.: Associated Intra-Abdominal Lesions Encountered During Resection of Aortic Aneurysms: Surgical Consideration , Dis. Colon Rectum 3:485-490 ( (Nov.-Dec.) ) 1960.Crossref 14. Poth, E. J., and McClure, J. N., Jr.: Intestinal Obstruction; the Protective Action of Sulfasuxidine and Sulfathalidine to the Ileum Following Vascular Damage , Ann. Surg. 131:159-170 ( (Feb.) ) 1950.Crossref 15. Sarnoff, S. J., and Fine, J.: The Effect of Chemotherapy on the Ileum Subjected to Vascular Injury , Ann. Surg. 121:74-82 ( (Jan.) ) 1945.Crossref 16. Sheranian, L. O.; Edwards, J. E., and Kirklin, J. W.: Late Results in 110 Patients with Abdominal Aortic Aneurysm Treated by Resectional Placement of Aortic Homograft , Surg. Gynec. Obstet. 109:309-314 ( (Sept.) ) 1959. 17. Smith, R. F., and Szilagyi, D. E.: Ischemia of the Colon as a Complication in the Surgery of the Abdominal Aorta , A.M.A. Arch. Surg. 80:806-820 ( (May) ) 1960.Crossref 18. Young, J. R.; Britton, R. C.; deWolfe, V. G., and Humphries, A. W.: Intestinal Ischemic Necrosis Following Abdominal Aortic Surgery, Surg. Gynec. Obstet., to be published.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jan 1, 1963

References

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