title: Aggressive management of nonocclusive ischemic colitis following aortic reconstruction.
abstract: OBJECTIVE
  Under standard conditions following aortic reconstruction, nonocclusive ischemic colitis (IC) type 1 (mucosal ischemia) and type 2 (mucosal and muscularis ischemia) can be managed nonoperatively, whereas type 3 (transmural ischemia) requires emergency surgery. Our objective was to standardize the surgical approach for IC complicating aortic reconstruction.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  General surgery, vascular surgery, anesthesiology, and critical care units in a university-affiliated hospital.
  
  
  METHODS
  From January 5, 1997, to December 15, 2003, 49 cases of IC complicating aortic reconstruction were diagnosed (rate, 2.7%). Nonoperative management was used for patients with type 1 or type 2 without multiple organ failure (MOF). All patients with type 3 or with type 2 with MOF underwent urgent resection of the ischemic colon without anastomosis.
  
  
  RESULTS
  Immediate surgery was performed on 24 patients (49.0%). Nineteen (76.0%) of 25 patients without MOF and with transient endoscopic findings underwent secondary surgery for progression to final IC type 3 (16 patients) or to final IC type 2 with MOF (3 patients). Twenty-three (53.5%) of 43 patients died after colorectal resection (overall mortality, 46.9%). Factors causing significant risk of death were surgery, MOF, final IC type, and amount of perioperative transfusion. The mortality was 57.1% for final IC type 3, 37.5% for final IC type 2 with MOF, and 0% for final IC type 1 or type 2 without MOF.
  
  
  CONCLUSIONS
  Selective management of postoperative IC, based on MOF and the degree of ischemia, is the suggested course of action. For patients with mild ischemia and MOF, an aggressive approach is recommended.
authors.affiliation: Department of General Surgery, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. fabrice.menegaux@psl.ap-hop-paris.fr
authors.forename: Fabrice
authors.initials: F
authors.lastname: Menegaux
authors.forename: Christophe
authors.initials: C
authors.lastname: Trésallet
authors.forename: Edouard
authors.initials: E
authors.lastname: Kieffer
authors.forename: Liliane
authors.initials: L
authors.lastname: Bodin
authors.forename: Dominique
authors.initials: D
authors.lastname: Thabut
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Rouby
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D003082:Colectomy / Q000379:methods*; D017091:Colitis, Ischemic / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*