| Abstract: Introduction: Colonic ischemia and intra-abdominal hypertension (IAHT) may be important factors in the development of multi-organ failure after operation for a rAAA and control of these complications may reduce mortality. The aim of this study was to study these factors prospectively and to identify the possible relations between colonic ischemia and IAHT.
Methods: Patients operated for rAAA were investigated prospectively. A tonometry catheter was placed in the lumen of the sigmoid colon immediately after surgery and intraluminal pCO2 was measured automatically every 10 minutes through an AS/3 monitor (Datex-Ohmeda, Helsinki, Finland). Intraabdominal pressure (IAP) was measured in the bladder every 4 hours. Patients with pHi <6.90 or IAP >20 mm Hg underwent colonoscopy. Conventional ICU-monitoring was performed.
Result: Ten patients (8 male and 2 female) were investigated during 2003. Mean age was 75 years. The median highest recorded postoperative IAP was 21 mm Hg (range 11-28). The median lowest recorded sigmoid colon pHi was 6.98 (range 6.59-7.20). One patient developed colonic ischemia with mucosal gangrene. In this patient the abdominal pressure was 28 mm Hg during 6 hours and pHi was <6.7 during 12 hours. The patient underwent colonoscopy, and was treated conservatively. After treatment the abdominal pressure decreased to 10 and pHi increased to 7.36. Five patients had sigmoid colon pHi <7.10 during ≤ 4 hours After treatment of suspected hypovolaemia, pHi was normalized in all these patients. Five patients had IAH > 20 mm Hg during 4 hours and all patients who continued to have low pHi and high abdominal pressure, underwent colonoscopy. All patients survived.
Conclusions: The patient who developed colonic ischemia had high IAP and low colonic pHi of considerable duration. If IAHT and sigmoid colon acidosis can be reversed timely, serious complications may be prevented. No mortality among 10 patients indicates that monitoring of IAP and of colonic pHi may improve outcome after operation for rAAA. The number of studied patients is not sufficient to draw major conclusions, but this study is in progress and we will be able to present a larger patient material at the meeting.
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