A CASE OF ISCHEMIC COLITIS FOLLOWING A RUPTURED ABDOMINAL AORTIC ANEURYSM

A case of ischemic colitis following abdominal aortic aneurysmectomy in a 74-year-old male is reported. The patient was admitted to the hospital with a complaint of severe abdominal pain. A ruptured abdominal aortic aneurysm was suspected, and emergency laparotomy was performed. At the operation a massive hematoma was encountered in the retroperitoneal space caused by rupture of an abdominal aortic aneurysm. Aneurysmectomy was performed uneventfully. The left colon appeared to be viable at the end of the procedure. Three days after the operation he had diarrhea, and the symptoms of bowel ischemia progressed. Colonoscopy on the 7th day after the first operation revealed ischemic colitis. He was treated conservatively for 2 weeks without significant improvement. On the 19th postoperative day uncontrollable massive melena occurred. Emergency laparotomy was carried out again, and resection of the left colon and transverse colostomy were done. The postoperative course after the second operation was uneventful, and the patient is doing well now. Although clinically significant ischemic colitis following aortic reconstruction is rare, colonoscopy after the operation is useful for early recognition of ischemic changes before clinical manifestations.