Ischemic colitis

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.

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).

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.

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.