title: The value of routine flexible sigmoidoscopy within 48 hours after surgical repair of ruptured abdominal aortic aneurysms.
abstract: BACKGROUND
  Left-sided colonic and rectal ischemia is commonly seen after surgery for ruptured abdominal aortic aneurysms (rAAAs) and is associated with increased mortality. Earlier studies have shown that flexible sigmoidoscopy (FS) may detect ischemia when performed postoperatively, and suggestions have been made that patients can be selected for FS based on clinical and biochemical parameters. We sought to perform FS in all patients surviving the first 24 hours after surgery for rAAA and to compare the findings of FS to clinical and biochemical parameters.
  
  
  METHODS
  All patients undergoing emergency surgery for rAAA and surviving the first 24 hours underwent FS to assess any degree of ischemia.
  
  
  RESULTS
  During the study period, 41 patients survived the first 24 hours after surgery. In 9 (22%) patients, some degree of colonic ischemia was found. Segmental necrosis was only shown in 5% at first FS. Patients with ischemia received more blood transfusions intraoperatively than those with normal findings at FS. They also had longer periods with mean blood pressure <60 mm Hg postoperatively, and lower arterial pH on the first postoperative day. Blood lactate levels did not differ between the groups. None of the parameters were sufficiently discriminative to be used for distinguishing between patients with and without ischemia.
  
  
  CONCLUSIONS
  Severe colonic ischemia was less common than previously reported. All cases of colonic ischemia were identified by early FS, but none of the clinical and biochemical parameters were sufficiently reliable to distinguish between patients with and without ischemia. It is suggested that all patients initially surviving surgery for rAAA should be offered FS to screen for colonic ischemia.
authors.affiliation: Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark. mikkel_tottrup@hotmail.com
authors.forename: Mikkel
authors.initials: M
authors.lastname: Tøttrup
authors.forename: Anette M
authors.initials: AM
authors.lastname: Fedder
authors.forename: Reinhold H
authors.initials: RH
authors.lastname: Jensen
authors.forename: Anders
authors.initials: A
authors.lastname: Tøttrup
authors.forename: Jesper
authors.initials: J
authors.lastname: Laustsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D017091:Colitis, Ischemic / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D003718:Denmark / Q000453:epidemiology; D003955:Diagnostic Tests, Routine / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012812:Sigmoidoscopy / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome