Acute ischaemic colitis: outcome in elderly patients

The Authors report the results of the management of ischaemic colitis in a surgical unit dedicated to elderly patients. Sixty-two elderly patients affected by ischaemic colitis were observed consecutively in the Surgery Unit of the University of L'Aquila from 1986 to 2004. The clinical records of the patients were retrospectively reviewed in order to assess clinical, biohumoral, endoscopic and x-ray findings pre- dictive of the most suitable type of treatment. Clinical follow-up was performed to evaluate the long-term prognosis after a mean period of 8 years post-treatment. Forty-six patients (74.1%) were treated by medical therapy only for a mean period of 7 days with a positive outcome and no mortality. Sixteen patients (25.9%) underwent surgery. Postoperative morbidity and mortality rates were 62.5% and 43.7%, respectively. Absence of bowel sounds (chi2 = 61.9, p < 0.001), ileus (chi2 = 17.8, p < 0.001) and air fluid levels in plain abdominal x-rays (chi2 = 18.6, p < 0.001) were risk factors for surgery. At follow-up a favourable outcome, without findings of recurrent acute or chronic ischaemic colitis, was observed in 55 patients. In conclusion, the results seem to suggest that medical therapy is the mainstay of treatment for acute ischaemic colitis in elderly patients with good clinical results. Peritonitis is an indication for surgery.