Open Repair of Ruptured Huge Aorto-Iliac Aneurysm: Warning of Colon Ischemia

Abstract

A giant abdominal aortic aneurysm (AAA) renders surgical treatment much more difficult by deforming the proximal infrarenal aortic neck (shortened length and disturbed angulation), by altering the iliac arteries (marked tortuosity and aneurysmal dilatation), and by displacing abdominal organs. Because the retroperitoneal rupture of giant AAA makes the mesentery more elongated and deformed, compromising its blood flow and thus increasing the risk of mesenteric ischemia such as colon ischemia. We describe here the surgical repair of a large infrarenal AAA with a ruptured huge left common iliac artery aneurysm of 13.5 cm in diameter, accompanied by colostomy due to colon ischemia which occurred during the operation. We discuss the pathophysiology and preventive strategy of colon ischemia during ruptured giant AAA repair.

Keywords: Abdominal aortic aneurysms; Ischemic colitis; Ruptured aneurysm.

Fig. 1.

Computed tomographic scan showing ruptured huge infrarenal abdominal aortic aneurysm (AAA), with angulated proximal infrarenal aortic neck but adequate enough for aortic cross-clam ping (black arrow) (A); AAA at aortic bifurcation (B); aneurysmal dilatation of both common iliac arteries (C); coronal view of AAA and rupture site (D).