J Korean Surg Soc.  2012 Mar;82(3):200-203. 10.4174/jkss.2012.82.3.200.

Report of a case of ischemic colitis with bilaterally patent internal iliac arteries after endovascular abdominal aneurysm repair

• Kim H
• Kwon TW
• Cho YP
• Moon KM

• KMID: 2212224
• DOI: http://doi.org/10.4174/jkss.2012.82.3.200

Abstract

During endovascular aneurysm repair (EVAR), interruption of the internal iliac arteries (IIAs) or the inferior mesenteric artery by stents or embolization is thought to cause colon ischemia. To minimize this risk, attempts have been made to preserve the IIAs using iliac branch devices or IIA revascularization. Here we present our experience of colon ischemia after EVAR in a patient with bilaterally patent IIAs without evidence of embolism. A 70-year-old man had abdominal pain and a ruptured abdominal aortic aneurysm was found. We performed EVAR with custom-made tube grafts preserving the bilateral IIAs. On postoperative day 2, the patient complained of abdominal pain, a sigmoidoscopy was performed revealing colon ischemia. On laparotomy, transmural infarction of the sigmoid colon was found and resected. Because IIA preservation cannot guarantee protection against colon ischemia, surgeons should maintain a high level of suspicion and use surveillance liberally after EVAR for early diagnosis of colon ischemia, even if both IIAs are preserved.

Keyword

Abdominal aortic aneurysm; Ischemic colitis; Iliac artery; Inferior mesenteric artery

MeSH Terms

Abdominal Pain
Aged
Aneurysm
Aortic Aneurysm, Abdominal
Colitis, Ischemic
Colon
Colon, Sigmoid
Early Diagnosis
Embolism
Humans
Iliac Artery
Infarction
Ischemia
Laparotomy
Mesenteric Artery, Inferior
Sigmoidoscopy
Stents
Transplants

Figure

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  Fig. 1 Preoperative computed tomography scan. Abdominal aortic aneurysm with contrast leakage (black arrow) was found (A), bilateral internal iliac arteries (white arrows, B) inferior mesenteric artery (arrowhead, C) were patent.

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  Fig. 2 Gross pictures of infarcted colon. Transmural infarction of sigmoid colon was found on laparotomy (A) and in surgical specimen (B).

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