Israeli D, Dardik H, Wolodiger F, Silvestri F, Scherl B, Chessler R
Vascular Surgery Service, Englewood Hospital and Medical Center, NJ 07631, USA.
J Vasc Surg. 1996 Apr;23(4):706-9. doi: 10.1016/s0741-5214(96)80053-x.
Ischemic colitis is an infrequent but potentially devastating complication of abdominal aortic reconstruction. Identification of patients with predisposing risk factors for the development of ischemic colitis can guide intraoperative measures to preserve or restore colonic blood flow during aortic surgery. Previous radiation therapy for pelvic malignancy may be one such predisposing risk factor. Two cases are presented in which ischemic colitis complicated abdominal aortic reconstruction in the setting of previous pelvic irradiation. In the months after radiation therapy for prostate cancer, one patient underwent infrarenal abdominal aortic aneurysm repair. Ischemic infarction of the sigmoid colon developed acutely after surgery and required emergent sigmoid colectomy. The second patient underwent reconstruction of an infrarenal abdominal aortic aneurysm after having had radiation therapy for a bladder tumor. Despite an initial satisfactory result, the patient's abdominal pain and diarrhea progressively worsened and he eventually required sigmoid colectomy for severe ischemic colitis. In both of these patients, the inferior mesenteric arteries were patent and had not been reimplanted. The association of pelvic radiation therapy with ischemic colitis after aortic reconstruction should focus attention to the operative details for maintaining the colonic circulation in these patients. Reimplantation of the inferior mesenteric artery in particular may prevent both the acute and the insidious variants of this complication in patients who undergo aortic surgery and decrease the incidence of this complication in patients with a history of radiation therapy to the pelvis.
缺血性结肠炎是腹主动脉重建术一种少见但可能具有毁灭性的并发症。识别具有缺血性结肠炎发生易患风险因素的患者，可指导在主动脉手术期间采取术中措施来维持或恢复结肠血流。既往盆腔恶性肿瘤放疗可能是其中一种易患风险因素。本文报告两例在既往盆腔放疗背景下缺血性结肠炎并发腹主动脉重建术的病例。在前列腺癌放疗后的数月，一名患者接受了肾下腹主动脉瘤修复术。术后乙状结肠急性发生缺血性梗死，需要急诊行乙状结肠切除术。第二名患者在膀胱肿瘤放疗后接受了肾下腹主动脉瘤重建术。尽管最初结果令人满意，但患者的腹痛和腹泻逐渐加重，最终因严重缺血性结肠炎需要行乙状结肠切除术。在这两名患者中，肠系膜下动脉均通畅且未进行再植。盆腔放疗与主动脉重建术后缺血性结肠炎的关联应促使关注这些患者维持结肠循环的手术细节。特别是肠系膜下动脉再植术可能预防接受主动脉手术患者该并发症的急性和隐匿性类型，并降低有盆腔放疗史患者该并发症的发生率。
