| 摘要 |
Objective: Major gastrointestinal complications described in the literature after aortic surgery are limited to intestinal ischemia. Gastrointestinal complications in the specific context of ruptured aortic abdominal aneurysm (AAA) repair have not been well-defined and are limited to descriptions of ischemic colitis. Our study was performed to better delineate the gastrointestinal complications associated with ruptured AAA repair and risk factors affecting outcomes.
Methods: Data from 100 consecutive patients who underwent ruptured AAA repair between July, 1980 and June, 2000 was analyzed in terms of age, circumstances of presentation, emergency room vital signs, per-operative comorbidities, pre-operative hematocrit and creatinine, emergency room to operating room time, operative blood pressure, clamp site, procedure, estimated blood loss, and blood products transfusion and intravenous fluid amount. These variables were assessed in terms of post-operative gastrointestinal complications, morbidity and mortality.
Results: Overall mortality for all patients was 48%. Gastrointestinal complications were encountered 29 times in 27 patients out of 100 total patients (27%). The complications included prolonged adynamic ileus (n=3), acute pancreatitis (n=4), acute cholecystitis (n=2), perforated duodenal ulcer (n=1), bowel obstruction (n=3), antibiotic associated colitis (n=6), ischemic colitis (n=3), bowel infarction (n=4) and liver failure (n=3). A comparison of patients with and without gastrointestinal complications showed no difference in the preoperative and intraoperative variables, length of stay, or mortality.
Conclusions: Gastrointestinal complications are common in ruptured aortic aneurysm repair. Cholecystitis and bowel ischemia carries high mortality and morbidity. Surgeons must maintain a high level of suspicion to anticipate the presence of possible gastrointestinal complications due to the lack of predictors. |
