Summary
Ischemic colitis after aortoiliac vascular reconstructions represents a seldom but life-threatening postoperative complication (incidence: 1.6%, mortality rate: 50–70%). The authors present a retrospective evaluation of 10 cases observed in a consecutive series of 1121 reconstructive aorto-iliac procedures. The incidence of ischemic bowel complications was 1.3% in the group of abdominal aortic aneurysms but only 0.6% in the group of arterial occlusive disease. The pathogenesis including new approaches of prophylaxis, diagnostic and therapeutical measures are discussed. The risk of ischemic damage to the bowel may be best assessed from the preoperative aortogram (special vascular patterns), the intraoperative stump-pressure measurement in the inferior-mesenteric artery and the pre- and postoperative PB-Index. In contrast to earlier reports the leading clinical symptom is an unexplained prolonged gastrointestinal paralysis during the first postoperative week. Early diagnosis is most important and best realized by the routine use of colonoscopy in all risk cases in the first 48 h. Such an aggressive diagnostic approach offers the possibility of early relaparotomy in a pretoxic stage and a better outcome for the patient than heretofore with a median delay of 11 days between vascular reconstruction and relaparotomy.
Zusammenfassung
Eine ischämische Darmwandschädigung im Gefolge aortoiliacaler Gefäßrekonstruktionen stellt zwar eine seltene, aber unmittelbar lebensbedrohliche postoperative Komplikation dar (Häufigkeit: 1–6%; Letalität: 50–70%). An Hand einer retrospektiven Analyse von 10 eigenen Beobachtungen im Gefolge von 1121 rekonstruktiven Eingriffen geben die Verff. eine Übersicht über die formale Genese, die Prophylaxe, Diagnostik und Therapie dieser Komplikation. Die Häufigkeit in der Aneurysmagruppe lag mit 1,3% doppelt so hoch wie in der AVK-Gruppe mit 0,6%. Das Ischämierisiko läßt sich in erster Linie an Hand des präoperativen Arteriogramms, einer routinemäßigen Stumpfdruckbestimmung in dér A. mesenterica inferior, ferner durch die Ermittlung des prä- und postoperativen PB-Indexes abschätzen. Klinisches Leitsymptom stellt eine protrahierte postoperative Magen-Darmatonie dar. Die Frühdiagnose ist von ausschlaggebender Bedeutung (routinemäßige Colonoskopie bei allen Risikofällen innerhalb der ersten 48 h). Relaparotomie mit Colonresektion können dann in einem prätoxischen Frühstadium mit größerer Erfolgschance durchgeführt werden.
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Vollmar, J.F., Fleischmann, W. Ischämische Colitis nach rekonstruktiven Eingriffen im aorto-iliacalen Gefäßabschnitt. Langenbecks Arch Chiv 363, 165–178 (1985). https://doi.org/10.1007/BF01261290
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DOI: https://doi.org/10.1007/BF01261290