Ten patients undergoing elective infrarenal aortic surgery were studied. Samples were taken perioperatively from a sigmoid tonometer to determine intramucosal pH (pHi) of the sigmoid colon, and simultaneously venous blood was taken for endotoxin measurement. Colonoscopy and biopsy were performed preoperatively and one week postoperatively. Significant endotoxemia was detected in 5 patients (50%), all of whom had transient colonic ischemia on the basis of tonometry, and of whom 2 had histologic evidence of ischemia at one week. Endotoxemia does occur during aortic surgery and appears to be associated with colonic ischemia, though this requires further evaluation.
Get full access to this article
View all access options for this article.
References
1.
Tollefson FJ , Ernst CB: Colon ischemia following aortic reconstruction . Ann Vasc Surg5:485-489, 1991.
2.
Ernst CB, Hagihara PF, Daugherty ME, et al: Inferior mesenteric artery stump pressure: A reliable index for safe IMA ligation during abdominal aortic aneurysmectomy. Ann Surg187:641-646, 1978.
3.
Ouriel K., Fiore WM, Geary JE: Detection of occult colonic ischaemia during aortic procedures: Use of an intraoperative photoplethysmographic technique. J Vasc Surg7:5-9, 1988.
4.
Bergman RT, Gloviczki P., Welch TJ, et al: The role of intravenous fluorescein in the detection of colon ischemia during aortic reconstruction. Ann Vasc Surg6:74-79, 1992.
5.
Lynch TG, Hobson RW II, Kerr JC, et al: Doppler ultrasound, laser Doppler, and perfusion fluorometry in bowel ischemia. Arch Surg123:483-486, 1988.
6.
Krohg-Sorensen K., Kvernebo K.: Laser Doppler flowmetry in evaluation of colonic blood flow during aortic reconstruction. Eur J Vasc Surg3:37-41, 1989.
7.
Fiddian-Green RG, Amelin PM, Herrmann JB, et al: Prediction of the development of sigmoid ischemia on the day of aortic operations. Arch Surg121:654-660, 1986.
8.
Fiddian-Green RG, Gantz NM: Transient episodes of sigmoid ischemia and their relation to infection from intestinal organisms after abdominal aortic operations. Crit Care Med15:835-838, 1987.
9.
van Deventer Sjh, Buller HR, ten Cate JW, et al: Endotoxemia: An early predictor of septicaemia in febrile patients. Lancetii:605-609, 1988.
10.
Brewster DC , Franklin DP, Camria RP, et al: Intestinal ischemia complicating abdominal aortic surgery. Surgery109:447-454, 1991.
11.
Seeger JM, Coe DA, Kaelin LD, et al: Routine reimplantation of patent inferior mesenteric arteries limits colon infarction after aortic reconstruction. J Vasc Surg15:635-641, 1992.
12.
Scheidler MG , Cutler BS, Fiddian-Green RG: Sigmoid intramural pH for prediction of ischemic colitis during aortic surgery. Arch Surg122:881-886, 1987.
13.
Simmons EL, McGonigle DJ, Harper HA, et al: Experimental aortic occlusion. Surgery53:677-688, 1963.
14.
Fiddian-Green RG: Studies in splanchnic ischemia and multiple organ failure. In: Splanchnic Ischemia and Multiple Organ Failure . ed. by Marston A, Bulkley GB, Fiddian-Green RG, et al. London: Edward Arnold/ St. Louis: CV Mosby, 1989.
15.
Papa M., Halperin Z., Rubenstein E., et al: The effect of ischemia of the dog's colon on transmural migration of bacteria and endotoxin. J Surg Res35:264-269, 1983.
16.
Palmer KR, Duerden BI, Holdsworth CD: Bacteriological and endotoxin studies in cases of ulcerative colitis submitted to surgery. Gut21:851-854, 1980.
17.
Kelley CJ, Ingoldby Cjh, Blenkhorn JI, et al: Colonoscopy related endotoxemia. Surg Gynecol Obstet161:332-334, 1985.
18.
Bayston KF, Cohen J.: Bacterial endotoxin and current concepts in the diagnosis and treatment of endotoxaemia. J Med Microbiol31:73-83, 1990.
