Ischemia of the Colon as a Complication in the Surgery of the Abdominal Aorta

In surgical procedures on the abdominal aorta the surgeon often faces the problem of the simultaneous obliteration of the inferior mesenteric artery, on the one hand, and of both internal iliac arteries, on the other, either as a necessary technical step in the operation (such as may be required in the management of aneurysms) or as a pathological lesion to be dealt with (such as is often encountered in occlusive disease). In the latter case, there is small cause for concern, since the insidious obliterative process of atherosclerosis provides time for the development of an ample collateral circulation, and a correction of the main occlusive lesion almost invariably assures adequate blood supply to the colon. In the case of aneurysms of the distal abdominal aorta, however, the occasion frequently arises when even the temporary sacrifice of the patency of the internal iliac arteries, together with the ligation of the inferior