Bowel and spine ischemia

Intestinal ischemia following aortic surgery involves the colon in almost all cases, and is caused by disruption of collateral blood flow to the bowel with the rectosigmoid region most commonly involved. The incidence in elective cases approaches 10 per cent, while nearly 60 per cent of patients with ruptured aneurysms will experience ischemic colitis. Overall mortality is 50 per cent, with rates as high as 90 per cent when there is transmural involvement. Diagnosis is often difficult because of normal postoperative discomfort; however, progressive distension, worsening peritoneal findings, sepsis, metabolic acidosis, and diarrhea should raise strong suspicion. Limited endoscopy to 40 cm is usually sufficient to establish the diagnosis, and repeat endoscopy can be used to follow mild cases. If there is no evidence of gangrene or full-thickness involvement, treatment consists of bowel rest and antibiotics. Further deterioration should be followed by exploration and resection of non-viable bowel with colostomy.

Spinal cord ischemia following aortic surgery is rare and is primarily caused by interruption of flow to the artery of Adamkiewicz, arising from the posterior division of an intercostal artery between T8 and L2 or from a lumbar branch. The incidence is highest in thoracic aortic reconstructions but can occur in repairing abdominal aortas, particularly when they are ruptured. As in most spinal cord injuries, treatment is supportive.

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