Related Experiment Video
Updated: Dec 21, 2025
Manufacturing Abdominal Aorta Hydrogel Tissue-Mimicking Phantoms for Ultrasound Elastography Validation
Published on: September 19, 2018
Value of Routine Flexible Sigmoidoscopy and Potential Predictive Factors for Colonic Ischemia after Open Ruptured
Sigitas Urbonavicius1,2, Ingrid Luise Feuerhake1,3, Reshaabi Srinanthalogen1
1Department of Vascular Surgery, Cardiovascular research Unit, Viborg Regional Hospital, 8800 Viborg, Denmark.
Insights
Colonic ischemia (CI) after ruptured abdominal aortic aneurysm (rAAA) repair is a serious complication. Postoperative lactate and hemoglobin levels are key indicators for identifying patients at higher risk of developing CI following rAAA surgery.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Critical Care Medicine
Background:
- Colonic ischemia (CI) is a significant complication following ruptured abdominal aortic aneurysm (rAAA) repair, contributing to increased patient morbidity and mortality.
- While flexible sigmoidoscopy can detect CI, its routine utility after rAAA repair remains unproven.
Purpose of the Study:
- To assess the effectiveness of routine flexible sigmoidoscopy in identifying CI post-rAAA repair.
- To identify hemodynamic, biochemical, and clinical predictors of CI development in patients undergoing rAAA surgery.
Main Methods:
- Retrospective analysis of 80 patients undergoing open rAAA repair between 2014 and 2017.
- Data collection included flexible sigmoidoscopy findings, CI incidence, and pre- and perioperative/postoperative hemodynamic, biochemical, and clinical variables.
- Logistic regression analysis was employed to determine the association between CI and potential predictors.
Main Results:
- Flexible sigmoidoscopy was performed in 73.5% of surviving patients.
- Perioperative lowest arterial pH and type of aortic graft (aortobifemoral bypass vs. straight graft) showed significant differences between CI groups.
- Postoperative highest lactate (Day 1) and lowest hemoglobin (Day 2) were significantly different in CI groups. Postoperative lactate and hemoglobin were identified as independent risk factors for CI (OR = 1.91 and OR = 0.44, respectively).
Conclusions:
- Flexible sigmoidoscopy can aid in identifying patients at increased risk of mortality after open rAAA repair.
- Postoperative lactate and hemoglobin levels are independent predictors for the development of colonic ischemia following open rAAA repair.
- Larger studies are recommended to validate these findings.
Abstract:
Background and Objectives: colonic ischemia (CI) after ruptured abdominal aortic aneurysm (rAAA) repair is associated with increased morbidity and mortality. CI may be detected by using flexible sigmoidoscopy, but routine use of flexible sigmoidoscopy after rAAA is not clearly proven. The objective of this study was to evaluate the efficacy of routine flexible sigmoidoscopy in detecting CI after rAAA repair, and to identify potential hemodynamic, biochemical, and clinical variables that can predict the development of CI in the patients who underwent rAAA surgery. Materials and Methods: we retrospectively included all rAAA cases treated in Viborg hospital from 1 April 2014 until 31 August 2017, recorded the findings on flexible sigmoidoscopy, and the incidence of CI. We collected specific hemodynamic, biochemical, and clinical variables, measured pre- and perioperatively, and the first three postoperative days. The association between CI and possible predictors was analyzed in a logistic regression model. Results: a total of 80 patients underwent open rAAA repair during the study period. Flexible sigmoidoscopy was performed in 58 of 80 patients (73.5%) who survived at least 24 h after open rAAA surgery. Perioperative variables lowest arterial pH (p = 0.02) and types of operations-aortobifemoral bypass vs. straight graft (p = 0.04) showed statistically significant differences between CI groups. The analysis of the postoperative variables showed statistically significant difference in highest lactate on postoperative day 1 (p = 0.01), and lowest hemoglobin on postoperative day 2 (p = 0.04) comparing CI groups. Logistic regression model revealed that postoperative hemoglobin and lactate turned out to be independent risk factors for the development of CI (respectively OR = 0.44 (95% CI = 0.29-0.67) and OR = 1.91 (95% CI = 1.2-3.05)). Conclusions: flexible sigmoidoscopy can identify patients being at higher risk of mortality after open rAAA repair. The postoperative lactate and hemoglobin were found to be independent risk factors for the development of CI after open rAAA repair. Further larger studies are warranted to demonstrate these findings.
Related Concept Videos
01:26Aneurysm III: Interprofessional Care
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:22Aneurysm IV: Nursing Management
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:25Endoscopic Procedures II: Colonoscopy
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...