ABSTRACT
We report a 90-year-old man with intestinal necrosis of the sigmoid colon after EVAR. His abdominal aortic aneurysm was 7.3 cm in diameter, and mural thrombus was present from the abdominal aortic aneurysm to the proximal common iliac arteries. Because type Ib endoleakage from the right distal edge of the stent graft was present, extension to the iliac bifurcation was performed using an additional leg device. The external iliac artery was severely calcified and tortuous ; thus, insertion of the leg device was technically difficult. Immediately after the operation, abdominal distention, right trash foot, and a small amount of rectal bleeding were observed. The patient was managed conservatively, and the symptoms resolved within a few days. Oral intake was started on postoperative day 5. However, 4 days after the initiation of oral intake, the patient suffered from abdominal pain and fever. Free air was observed by chest X-ray and computed tomography. Emergency laparoscopic examination revealed intestinal necrosis and perforation of the sigmoid colon. Therefore, the sigmoid colon was resected, and a transverse colostomy was performed. The patient recovered relatively well, with oral food intake beginning on day 6 and rehabilitation on day 8. He was discharged in good condition with unaided ambulation 5 weeks after bowel resection. Pathological examination demonstrated ischemic colitis due to cholesterol emboli.