Intestinal Ischemia after Vascular Surgery of Abdominal Aortic Aneurysm

腹部主動脈瘤術後之缺血性大腸炎

10.6200/TCMJ.2006.3.3.10

楊明叡(Ming-Jui Yang)；羅永男(Yung-Nan Luo)；沈陳石泉(Shie-Chuan Sheen Chen)；劉茂和(Mau-Ho Liu)

腹部主動脈瘤 ； 缺血性大腸炎 ； 哈特曼氏手術 ； abdominal aortic aneurysm ； ischemic colitis ； Hartmann's operation

北市醫學雜誌

3卷3期（2006 / 03 / 01）

288 - 293

英文

缺血性大腸炎變化，大部分是發生在老年人的腸道缺血性傷害。初期都是進行內科治療，僅有少數併發大腸壞死、穿孔或阻塞性狹窄時，才須要進行外科手術治療。臺北市立聯合醫院仁愛院區外科提出一例腹部主動脈瘤病人接受緊急手術，術後發生脊髓損傷半身不遂，以及缺血性大腸炎合併大腸阻塞的病例，施行部分大腸切除及腸造口緊急外科治療，手術後病人恢復但仍有半身不遂。我們提出此一臨床病例報告並作相關文獻回顧。我們要注意腹部主動脈瘤病人接受緊急手術，術後有可能發生包括缺血性大腸炎或大腸壞死等的併發症，須進行緊急外科手術。我們認為臨床上密切觀察病情變化；及早做大腸鏡檢。如有大腸壞死變化的併發症，需及早接受外科治療，以降低死亡率。

Ischemic colitis (IC) is a disease process of large bowel that is usually seen in the elderly. Most cases undergo spontaneous remission after initial medical treatment. Emergent surgery is promptly indicated when there is any of the conditions such as colonic infarction, impending perforation or chronic stricture. We reported one case of complicated ischemic colitis who underwent segmental colectomy and colostomy, because of gastrointestinal complication following emergent surgery for abdominal aortic aneurysm (AAA). He was recovered post-operatively, but with the preexistent sequele of paraplegia due to spinal cord injury from vascular surgery. We presented this case and also reviewed the related literature in the text. We must be alert with high suspicion for IC in the patients with aortic surgical procedures, for early detection and adequate treatment of this complication. We emphasize that a more liberal use of postoperative colonoscopy could allow detecting colonic ischemia, also surgically treating colonic necrosis at an earlier stage and reduce ensuing mortality.