Management of Severe Aortic Stenosis and Bowel Obstruction

Patient Assessment and Initial Management

Evaluate patient stability using criteria such as low blood pH, low core temperature, base excess, evidence of coagulopathy, or signs of sepsis/septic shock including need for inotropic support, as recommended by the World Journal of Emergency Surgery 1
Assess for signs of peritonitis, sepsis, and hemodynamic instability which would necessitate immediate intervention, according to the World Journal of Emergency Surgery 2, 3
Perform close monitoring of cardiac function with consideration of invasive hemodynamic monitoring during surgery, as suggested by the World Journal of Emergency Surgery 4

For unstable patients with septic shock, peritonitis, or complete obstruction, immediate damage control surgery should be prioritized, as recommended by the World Journal of Emergency Surgery 1
Right-sided colon cancer with obstruction: right colectomy with terminal ileostomy is the procedure of choice, according to the World Journal of Emergency Surgery 5
Left-sided colon cancer with obstruction: Hartmann's procedure is the procedure of choice, as suggested by the World Journal of Emergency Surgery 5
Self-expandable metallic stents (SEMS) can relieve obstruction and allow time for cardiac optimization in high-risk patients with severe aortic stenosis, according to the World Journal of Emergency Surgery 4

After cardiac optimization, proceed with definitive colon cancer surgery, with right colectomy with primary anastomosis preferred for right-sided colon cancer if the patient is stable, as recommended by the World Journal of Emergency Surgery 6
For left-sided colon cancer, Hartmann's procedure is often safest in this high-risk population, according to the World Journal of Emergency Surgery 5

Antibiotic therapy targeting gram-negative bacilli and anaerobic bacteria is recommended due to potential bacterial translocation, as suggested by the World Journal of Emergency Surgery 2
Close communication between surgeon, anesthesiologist, and cardiologist is essential to assess effectiveness of resuscitation and determine optimal treatment, according to the World Journal of Emergency Surgery 1
Laparoscopic approaches may be considered in hemodynamically stable patients to reduce length of stay and morbidity, as recommended by the World Journal of Emergency Surgery 7
Avoid prolonged hypotension during surgery as it may precipitate cardiac events in patients with severe aortic stenosis, according to the World Journal of Emergency Surgery 4

Delaying intervention in patients with complete obstruction or signs of peritonitis, as warned by the World Journal of Emergency Surgery 2
Attempting primary anastomosis in hemodynamically unstable patients, as cautioned by the World Journal of Emergency Surgery 5
Creating stomas in patients who may require open abdomen management, as advised by the World Journal of Emergency Surgery 5