Intestinal ischemia after abdominal aortic surgery

Q: 52 years old male is admitted to the ICU after abdominal aortic dissection repair. 24 hours post-surgery, the patient complains of acute abdominal pain. CTA of the abdomen is consistent with acute colonic ischemia. Which side of the colon is probably affected?

A) Left

B) Right

Answer: A

With open aortic surgery, colonic ischemia almost always affects the distal left colon. Some of the surgical causes are:

• loss of collateral flow due to inferior mesenteric artery ligation
• iliac artery ligation
• embolic events
• vascular compression with surgical instruments
• hypotension leading to hypoperfusion

On a similar note, some cardiac interventions, such as cardiac catheterization or valve implantation, can also cause colonic ischemia.

#surgical-critical-care

#GI

References:

1. Abromaitis D, Antusevas A. Zarnyno isemijos prevencija po pilvo aortos rekonstrukciniu operaciju [Prevention of intestinal ischemia after abdominal aortic reconstructive surgery]. Medicina (Kaunas). 2005;41(4):295-304. Lithuanian. PMID: 15864002.

2. Ding P, Zhou Y, Long KL, Zhang S, Gao PY. Acute mesenteric ischemia due to percutaneous coronary intervention: A case report. World J Clin Cases. 2022 Oct 6;10(28):10244-10251. doi: 10.12998/wjcc.v10.i28.10244. PMID: 36246830; PMCID: PMC9561597.

3. Michalopoulos GC, Bikeyeva V, Paolella G, Adams J, Labchuk A, Chaus A. Non-occlusive Mesenteric Ischemia Following Transcatheter Aortic Valve Replacement: A Case Report. Cureus. 2025 Jul 7;17(7):e87468. doi: 10.7759/cureus.87468. PMID: 40630765; PMCID: PMC12237081.