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[ColonTODAY 044 - Ischemic colitis after abdominal aortic aneurysm surgery]

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NSTEMI로 PCI 받은 환자에서 복부대동맥류가 발견되었고 크기가 증가하여 수술을 하였습니다. 며칠 후 shock, fever, AKI가 발견되어 십이지장경을 하였고 현저한 허혈성 변화가 발견되었습니다. 아울러 rectal cancer로 진단되었습니다. 수술을 시행하였습니다.

Rectum, anterior resection:
Adenocarcinoma, moderately differentiated
1. Location: rectum
2. Gross type: ulceroinfiltrative
3. Size: 3x2.9 cm
4. Depth of invasion: invades muscularis propria(pT2)
5. Resection margin: free from carcinoma
6. Regional lymph node metastasis : no metastasis in all 12 regional lymph nodes(pN0) (0/12: perirectal, 0/12)
7. Lymphatic invasion: not identified
8. Venous invasion: not identified
9. Perineural invasion: not identified
10. Tumor budding : negative
11. Pathologic staging: pT2 N0

Extensive mucosal ischemic change and transmural inflammation, consistent with ischemic colitis


[Mini-review on Intestinal ischemia]

1) Colonic ischemia is predominant form of intestinal ischemia and is related to endograft coverage of IMA.

2) occurs in 1~3 % of patients following endovascular aneurysm repair.

3) review of 1174 pts AAA repair (open or endovascular)
- endovascular was associated with higher rates of colonic ischemia than open repair (4 versus 1.4 percent).
- Independent risk factors for colonic ischemia
- aneurysm rupture, duration of op >4 hrs, cr >200 mol/L


[References]

1) EsoTODAY - Esophageal diseases

2) SmallTODAY - Small bowel diseases

3) ColonTODAY - Colorectal diseases

© 일원내시경교실 바른내시경연구소 이준행. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.