Clinical surgery–International
Ischemic colitis

https://doi.org/10.1016/j.amjsurg.2005.09.018Get rights and content

Abstract

Background

Ischemic colitis almost always occurs in older patients. Because life expectancy is increasing, more and more often physicians will face this problem. The aim of this study was to identify factors leading to surgery in the acute phase of the disease, and to evaluate mortality and long-term follow-up evaluation.

Methods

We performed a retrospective study of 73 patients (mean age, 73 y) in the Department of General and Digestive Surgery. Diagnosis was obtained by endoscopic and pathologic procedures. The median follow-up period was 4.5 years (range, 2–9 y).

Results

Thirty-six patients had 1 or more co-existing medical diseases. All the patients had either lower intestinal bleeding (45 patients) or diarrhea (28 patients). Thirty-three patients had undergone surgery (45%). In the surgical group, 13 patients underwent immediate surgery for abdominal tenderness and/or shock. Eight of these patients died (62%). Out of 60 patients undergoing nonsurgical immediate management, 1 patient died (septic shock). Delayed surgery was indicated in 20 out of the 59 remaining patients for clinical or endoscopic aggravation. Six of these patients died (30%). Multivariate analysis selected 4 factors of severity: age younger than 80 years, male sex, absence of bleeding, and abdominal tenderness. In the follow-up period 13 patients died from a cardiovascular disease. The 2- and 5-year actuarial survival rates of patients who survived the initial hospitalization were 88% and 68%, respectively.

Conclusions

Multivariate analysis selected the risk factors of severity. In severely ill patients serial endoscopic evaluations are the best indicator for surgery before appearance of tenderness, septic shock, full-thickness gangrene, and perforation. At discharge, anticoagulant or anti-arrhythmic therapy should be considered for patients who have cardiovascular disease.

Section snippets

Patients and Methods

This retrospective study included 73 consecutive patients (51 women, 22 men; mean age, 73 y; range, 18–91 y) hospitalized in a University Department of general and digestive surgery from 1992 to 1999 for ischemic colitis. Cases of recurrent ischemic colitis and of ischemic colitis after aortic surgery or associated with obstructing colon carcinoma were excluded. For all patients, the diagnosis was documented pathologically either on examination of the surgical specimen or on biopsy specimens

Results

The past medical history of 25 patients included ischemia involving the myocardium (n = 20), and/or the lower limbs (n = 9), and/or the brain (n = 6). A cardiac arrhythmia was present in 18 patients and diabetes mellitus was present in 6. No patient had chronic renal failure. The use of drugs, suggested to be associated with an increased risk of ischemic colitis, was noted in 16 patients. This comprised anticonvulsants in 7 patients, cardiac glycoside in 6, diuretics in 6, and nonsteroidal

Comments

The spontaneous and usually self-limiting form of ischemic colitis contrasts with the fulminant or severe form. The rate of self-resolution of symptoms varies widely from medical to surgical experiences. In a medical series including 88 consecutive patients, the immediate course was uneventful in 92% of patients [7]. In surgical experiences, as in the present series, this rate was around 50% [8]. Ischemic colitis may be mistaken for fulminant Clostridium difficile colitis. The later presents

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