[Ischemic colon and rectum necrosis after resection of the abdominal aorta]

Colorectal infarctions are a rare but serious complication following aortoiliac reconstruction. Their incidence has been reported to be about 2% in retrospective and 7-35% in prospective studies. The perioperative mortality rate reaches 40-75%. About 85% of these ischemic lesions follow resection of the infrarenal aorta because of aneurysm, only 15% after aortoiliac occlusive disease. Principal cause of the infarctions is the ligation of the inferior mesenteric artery without sufficient collateral circulation. Blood supply of the large intestine and pathogenesis of ischemic colitis are discussed in detail. The pathological and clinical presentation contains three intensity degrees. For early detection colonoscopy is useful. Prevention preoperatively consists of precise analysis of aortography, intraoperatively in perfusion control of visceral arteries. The best precaution is reimplantation of the inferior mesenteric artery into the prosthetic graft.