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Original Article
July 1, 2006

Aggressive Management of Nonocclusive Ischemic Colitis Following Aortic Reconstruction

Author Affiliations

Author Affiliations: Departments of General Surgery (Drs Menegaux and Tr[[eacute]]sallet), Vascular Surgery (Dr Kieffer), Anesthesiology and Critical Care (Drs Bodin and Rouby), and Hepatogastroenterology (Dr Thabut), Groupe Hospitalier Piti[[eacute]]-Salp[[ecirc]]tri[[egrave]]re, Assistance Publique[[ndash]]H[[ocirc]]pitaux de Paris, Universit[[eacute]] Pierre et Marie Curie (Paris VI), Paris, France.

Arch Surg. 2006;141(7):678-682. doi:10.1001/archsurg.141.7.678
Abstract

Hypothesis  Under standard conditions following aortic reconstruction, nonocclusive ischemic colitis (IC) type 1 (mucosal ischemia) and type 2 (mucosal and muscularis ischemia) can be managed nonoperatively, whereas type 3 (transmural ischemia) requires emergency surgery. Our objective was to standardize the surgical approach for IC complicating aortic reconstruction.

Design  Retrospective cohort study.

Setting  General surgery, vascular surgery, anesthesiology, and critical care units in a university-affiliated hospital.

Methods  From January 5, 1997, to December 15, 2003, 49 cases of IC complicating aortic reconstruction were diagnosed (rate, 2.7%). Nonoperative management was used for patients with type 1 or type 2 without multiple organ failure (MOF). All patients with type 3 or with type 2 with MOF underwent urgent resection of the ischemic colon without anastomosis.

Results  Immediate surgery was performed on 24 patients (49.0%). Nineteen (76.0%) of 25 patients without MOF and with transient endoscopic findings underwent secondary surgery for progression to final IC type 3 (16 patients) or to final IC type 2 with MOF (3 patients). Twenty-three (53.5%) of 43 patients died after colorectal resection (overall mortality, 46.9%). Factors causing significant risk of death were surgery, MOF, final IC type, and amount of perioperative transfusion. The mortality was 57.1% for final IC type 3, 37.5% for final IC type 2 with MOF, and 0% for final IC type 1 or type 2 without MOF.

Conclusions  Selective management of postoperative IC, based on MOF and the degree of ischemia, is the suggested course of action. For patients with mild ischemia and MOF, an aggressive approach is recommended.

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