Infarction of the left colon was noted in about 2% of patients undergoing reconstruction of the distal aorta with interruption of the inferior mesenteric artery, and was associated with a mortality of 65%. The injury involved only the mucosa and healed completely in a few patients. In others the deeper layers were impaired and delayed strictures developed. Full-thickness necrosis was followed by perforation in the third group. Diarrhea, sometimes bloody, was the most helpful finding which led to the diagnosis but was absent in one third of the patients.
Prevention of the complication involves avoiding hypotension, trauma to the colon, and interruption of collateral arterial supply. Treatment required resection of the injured bowel and staged restoration of colon continuity when infarction extended beneath the mucosa.
Ottinger LW, Darling RC, Nathan MJ, Linton RR. Left Colon Ischemia Complicating Aorto-Iliac ReconstructionCauses, Diagnosis, Management, and Prevention. Arch Surg. 1972;105(6):841-846. doi:10.1001/archsurg.1972.04180120022006