Sigmoid colon exteriorization after ruptured abdominal aortic aneurysm

A 74-year-old man in shock was transferred to our hospital. A ruptured abdominal aortic aneurysm was diagnosed by computed tomography and an emergency operation was thereafter performed. At operation, a massive hematoma was encountered in the retroperitoneal space and a standard aneurysmectomy with bifurcated graft replacement was carried out. At the end of the operation, signs of sigmoid colonic ischemia were recognized, including mild discoloration and bowel spasm. After considering the recovery or deterioration from colonic ischemia, we chose to exteriorize the sigmoid colon. On the 4th postoperative day, patchy ischemic areas of an elevated sigmoid colon were noticed to worsen and as a result, we were forced to perform a sigmoid colectomy with end colostomy. Thereafter, the patient developed multisystem organ failure, but he recovered gradually. The patient was discharged from the hospital 3 months after the initial operation. As a complication after surgery for abdominal aortic aneurysms, colonic ischemia remains a serious problem, especially in cases of ruptured AAA. It is generally better to avoid an operation for both abdominal aortic aneurysms and a colon resection at the same time. In this case, an exteriorization of the sigmoid colon was selected for the 1st operation in order to treat a ruptured abdominal aortic aneurysm. This surgical modality was found to be useful for making a correct diagnosis of colonic ischemia before the perforation, while a 2nd look operation for colonic ischemia could thus be performed under conditions of a reduced risk of infection to the prosthetic graft. These operative procedures were considered to be important factors in saving the patient's life.