Suspected reasons of colon-necrosis, following coronary operations

Between 15th of May and 15th of November 2003 at the Cardiovascular Surgery, 243 coronary bypass operations were carried out.

Among these in 8 patients abdominal complaints have been developed within 1–3 days following the heart-operation. All of these patients had abdominal distension, bowel-paralysis and physical signs of peritonitis. All patients – except one – were operated on 2–4 days after the cardiac-operation at the 2nd Department of Surgery. During the course of operation in all cases – except one – the necrosis of ascending colon could be observed, and right hemicolectomy was performed. Three patients were reoperated after the colon resection, because of anastomosis leakage. 6 patients have been died in the perioperative period. During the necropsy anastomotic laekega was found with peritonitis – all cases.

We evaluated the prae- and intraoperative circumstances of cardiac operations, the uneventful hours postoperatively also, and we compared those data with the same data of recovered patients too. We analysed the results of histological, and bacteriological examinations and the necropsy results too.

The bowel preparation, thrombo- and antibiotic profilaxis was changed in this period.

Why was the right colon the target place at necrosis in all cases?

Why anastomotic-laekage developed again and again, though the anastomosis was done with intact bowel-parts?

In 5 cases (among which 4 have been died) Clostridium difficile infection could be proved. At the time of positive test the patients were already in end-stage, and therapy was ineffective. Further examinations are needed to avoid similar cases in the future.