Slovenská chirurgia 3/2012

Nonocclusive ischemic colitis after abdominal aortic aneurysm resection: our experiences and summary of issues

Introduction: Nonocclusive ischemic colitis (NOIC) after abdominal aortic surgery is relatively rare, but serious diagnosis with high letality. Patients: During the period from 01/2007 to 10/2010, 73 patients underwent surgical treatment of abdominal aortic aneurysm (AAA), 23 of them for rupture. During the postoperative period three cases of NOIC have occurred (4.1%) resulting in the surgical intervention – two after rupture(8.7%) and one after elective surgery (2.0%). Discussion: In summary of personal experience and literary sources, the authors present current knowledge about the NOIC related to the prediction, prevention, distribution according to clinical course and finally to the diagnosis and treatment of this important nosological entity, including certain future onsights. Notably both the i-FABP and the D-lactate appear to be promising specific markers of the gut mucosal ischemia, and therefore useful for the early NOIC diagnosis.Conclusion: The NOIC is a serious complication of the surgical AAA repair with ominous letality. The careful monitoring of patients with the use of currently available methods (clinical findings, biochemical and metabolic inflammation markers, bedside colonoscopy, CT scan) can lower letality to 50%. In spite of the future availability of up-to-date diagnostic methods the key problem of early thought on this deletrious condition lays in our more or less prepared minds.

Keywords: Nonocclusive ischemic colitis, abdominal aortic aneurysm, i-FABP, D-lactate.