Abstract
Background: For colonic ischemia following abdominal aortic repair, there has been no specific treatment other than resection of necrotic colon or bowel rest with fluid replacement and administration of antibiotics. Here, we report the usefulness of octreotide for non-transmural colonic ischemia. Methods: From 2000 to 2007, colonoscopic studies were done for cases who experienced diarrhea or high fever after abdominal aortic or iliac arterial aneurysm repair. We administered octreotide subcutaneously (50–100μg twice a day) to patients with colonic ischemia of the mucosa (grade 1) or of the mucosa and the muscular layer (grade 2), confirmed by endoscopy. Effectiveness of octreotide was determined by lessening of diarrhea and endoscopic improvement. Results: During this period, 187 cases (42, rupture; 145, non-rupture) underwent abdominal aortic or iliac arterial aneurysm repair. Seven cases (4, rupture; 3, non-rupture) of colonic ischemia were identified by colonoscopy. The incidence of colonic ischemia was 9.5% for rupture and 2.1% for non-rupture. After administration of octreotide, fever or diarrhea improved within 24 hours in 6 of the 7 cases (86%), and complete resolution of diarrhea within 2 days was observed in 5 cases. Improvement of colonic ischemia (narrowing of ulcer and regeneration of surrounding mucosa) was also recognized by colonoscopy. No patients required colectomy for secondary colonic stricture. Conclusions: Although the mechanism is unclear, octreotide seemed to be effective for non-transmural colonic ischemia (grades 1 and 2) following abdominal aortic aneurysm repair.
