Colon infarction after ruptured abdominal aortic aneurysm
M. H. Meissner and K. H. Johansen
Harborview Medical Center, University of Washington School of Medicine, Seattle.
Colon infarction is a lethal complication of ruptured abdominal aortic
aneurysm. We compared multiple anatomic, hemodynamic, and clinical features
in 25 patients with ruptured abdominal aortic aneurysm who suffered colon
ischemia and 25 initial survivors of ruptured abdominal aortic aneurysm in
whom this complication did not develop. Prior impressions notwithstanding,
preoperative shock or volume administration did not correlate with the
development of colon ischemia, nor did aneurysm location, cross-clamp site,
graft type, or inferior mesenteric artery patency. However, patients with
colon ischemia had a significantly lower perioperative cardiac output and
were significantly more likely to have received alpha-adrenergic
vasoconstrictor agents. Seventeen patients (68%) with colon ischemia died
compared with nine patients (36%) without colon ischemia. Perioperative
maintenance of cardiac output and avoidance of alpha-adrenergic vasopressor
agents are critical elements in prevention of this lethal complication.
