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CASE REPORTS  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2003 April;44(2):263-5

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Sigmoid colon exteriorization after ruptured abdominal aortic aneurysm

Funahashi S., Osoegawa A., Matsumata T.

Department of Surgery, Section of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Fukuoka, Japay


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A 74-year-old man in ­shock was trans­ferred to our hos­pital. A rup­tured abdom­inal ­aortic aneu­rysm was diag­nosed by com­puted tomog­raphy and an emer­gency oper­a­tion was there­after per­formed. At oper­a­tion, a mas­sive ­hematoma was encoun­tered in the ret­ro­per­i­to­neal ­space and a stan­dard aneu­rys­mec­tomy ­with bifur­cated ­graft replace­ment was car­ried out. At the end of the oper­a­tion, ­signs of sig­moid ­colonic ­ischemia ­were rec­og­nized, ­including ­mild dis­color­a­tion and ­bowel ­spasm. ­After con­sid­ering the ­recovery or dete­ri­ora­tion ­from ­colonic ­ischemia, we ­chose to exte­ri­orize the sig­moid ­colon. On the ­4th post­op­er­a­tive day, ­patchy ­ischemic ­areas of an ele­vated sig­moid ­colon ­were ­noticed to ­worsen and as a ­result, we ­were ­forced to per­form a sig­moid colec­tomy ­with end colos­tomy. There­after, the ­patient devel­oped mul­ti­system ­organ ­failure, but he recov­ered grad­u­ally. The ­patient was dis­charged ­from the hos­pital 3 months ­after the ­initial oper­a­tion. As a com­pli­ca­tion ­after sur­gery for abdom­inal ­aortic aneu­rysms, ­colonic ­ischemia ­remains a ­serious ­problem, espe­cially in ­cases of rup­tured ­AAA. It is gen­er­ally ­better to ­avoid an oper­a­tion for ­both abdom­inal ­aortic aneu­rysms and a ­colon resec­tion at the ­same ­time. In ­this ­case, an exter­i­or­iza­tion of the sig­moid ­colon was ­selected for the 1st oper­a­tion in ­order to ­treat a rup­tured abdom­inal ­aortic aneu­rysm. ­This sur­gical ­modality was ­found to be ­useful for ­making a cor­rect diag­nosis of ­colonic ­ischemia ­before the per­fo­ra­tion, ­while a ­2nd ­look oper­a­tion for ­colonic ­ischemia ­could ­thus be per­formed ­under con­di­tions of a ­reduced ­risk of infec­tion to the pros­thetic ­graft. ­These oper­a­tive pro­ce­dures ­were con­sid­ered to be impor­tant fac­tors in ­saving the ­patient’s ­life.

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