Abdominal aortic aneurysm in a patient presenting with ischemic colitis

Area of Science:

• Vascular Surgery
• Aortic Aneurysm Research
• Surgical Technique Optimization

Background:

• Abdominal aortic aneurysm (AAA) management presents complex surgical challenges, particularly with concomitant iliac artery disease.
• Ischemic colitis can be an initial presentation of AAA, requiring careful patient assessment and management.
• Infrarenal AAA with mural thrombus and bilateral iliac stenosis necessitates tailored surgical intervention.

Observation:

• A 76-year-old male patient presented with ischemic colitis, later diagnosed with an infrarenal AAA.
• Preoperative imaging revealed infrarenal AAA with mural thrombus, right common iliac artery stenosis, and left internal iliac artery stenosis.
• The patient underwent successful aortoiliac bypass surgery with stenosis resection and left internal iliac artery reconstruction.

Findings:

• The extraperitoneal approach facilitated aortic access and reconstruction.
• Simultaneous reconstruction of both internal iliac arteries was achieved.
• Postoperative recovery was uneventful, with no recurrence of bowel ischemia or other complications.
• The use of prostaglandin E1 was noted as part of the treatment regimen.

Implications:

• This case underscores the benefits of the extraperitoneal approach for complex AAA repair.
• Reconstruction of both internal iliac arteries is crucial for adequate pelvic perfusion in selected AAA cases.
• The successful outcome suggests that prostaglandin E1 may play a beneficial role in preventing postoperative ischemia.