[HSF] Any One Had This Complication?

[Hgrmd at aol.com]

Dear Members,
  Last Friday was a tough day at the office.  First I did a  mitral, 
tricuspid, Cox-maze, CABG x1 on a 72 yo lady.  I then did an AVR,  MVR (heavily 
calcified posterior annulus), tricuspid, CABG x 4, Cox-maze on a 78  yo man.  His 
past history was notable for the fact that he had an  aorto-enteric fistula 
(previous AAA repair) requiring excision of the graft and  a right 
axillary-bifemoral bypass.  Intraop, I noticed that the LIMA had  unusually brisk flow.  
About 4 hours postop, he had a bright red  stool.  NG aspirate nonbloody.  By 
yesterday afternoon, he had begun  to develop abdominal tenderness.  He had a lap 
in the early evening.   There was a dead colon requiring resection.  The small 
bowel reportedly  looked ischemic, but viable.  He's much better this 
morning, though he's  now developed ATN.  His heart is working great.  It'll be a 
struggle,  but I'm cautiously optimistic he'll make it.  Anybody seen this  
scenario?
 
Hal



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