PURPOSE: To report a case of colonic infarction following endovascular abdominal aortic aneurysm (AAA) repair in a patient with both internal iliac arteries (IIA) unobstructed by the endograft. CASE REPORT: A 73-year-old man presented with blue toes as a result of emboli from a 6.4-cm AAA. As he was medically at high risk for open repair and his aneurysm morphology was suitable for a modular bifurcated endovascular graft, a Zenith endograft was used to exclude the aneurysm. Twenty hours after the successful procedure, in which both IIAs were preserved, the patient regurgitated coffee-ground vomit; an upper gastrointestinal endoscopy found a small Mallory-Weiss tear and antral gastritis. A proton-pump inhibitor was begun, but his symptoms progressed. Laparotomy revealed transmural ischemia and infarction of the upper rectum, sigmoid, descending colon, and the splenic flexure; a colonic resection with formation of Hartmann's pouch and colostomy was performed. He made a slow but uncomplicated recovery. CONCLUSIONS: Colonic necrosis can complicate endovascular AAA repair even when both IIAs are preserved. Advantageously, the clinical signs of severe colonic ischemia in endograft patients are not obscured by aftereffects of a laparotomy.
PURPOSE: To report a case of colonic infarction following endovascular abdominal aortic aneurysm (AAA) repair in a patient with both internal iliac arteries (IIA) unobstructed by the endograft. CASE REPORT: A 73-year-old man presented with blue toes as a result of emboli from a 6.4-cm AAA. As he was medically at high risk for open repair and his aneurysm morphology was suitable for a modular bifurcated endovascular graft, a Zenith endograft was used to exclude the aneurysm. Twenty hours after the successful procedure, in which both IIAs were preserved, the patient regurgitated coffee-ground vomit; an upper gastrointestinal endoscopy found a small Mallory-Weiss tear and antral gastritis. A proton-pump inhibitor was begun, but his symptoms progressed. Laparotomy revealed transmural ischemia and infarction of the upper rectum, sigmoid, descending colon, and the splenic flexure; a colonic resection with formation of Hartmann's pouch and colostomy was performed. He made a slow but uncomplicated recovery. CONCLUSIONS:Colonic necrosis can complicate endovascular AAA repair even when both IIAs are preserved. Advantageously, the clinical signs of severe colonic ischemia in endograft patients are not obscured by aftereffects of a laparotomy.