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[Predictive factors of mortality in severe ischaemic colitis: post-operative analysis of 101 patients]
Daniel Serralta De Colsa1, Irene Arjona Medina, Andrés García-Marín
1Servicio de Cirugía General y del Aparato Digestivo 2, Hospital General Universitario Gregorio Marañón, Madrid, España. lallamaquellama79@hotmail.com
Insights
Ischaemic colitis (IC) surgery has a high mortality rate, especially when diagnosed post-operatively or with transmural necrosis. Early diagnosis of bowel ischaemia is crucial for improving patient outcomes.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Vascular Surgery
Context:
- Ischaemic colitis (IC) is the most common form of bowel ischaemia.
- IC is frequently under-diagnosed, leading to delayed treatment.
- Surgical intervention is sometimes required for severe cases of IC.
Purpose:
- To report surgical outcomes in patients with IC.
- To identify predictors of mortality in surgically treated IC patients.
Summary:
- A study analyzed 101 surgically treated IC patients (1991-2006).
- High rates of morbidity (39.6%) and mortality (41.6%) were observed.
- Post-operative diagnosis (68% mortality) and transmural necrosis (93% mortality) were significant negative predictors.
Impact:
- Surgical management of IC carries substantial risk.
- Timely diagnosis is critical for reducing mortality in bowel ischaemia.
- Identifying high-risk factors can guide clinical decision-making and improve patient care.
Introduction:
Ischaemic colitis (IC) is the most common form of bowel ischaemia and is often under-diagnosed.
Objectives:
To report the results obtained in patients with IC who required surgical intervention in our Hospital, and to evaluate the predictive factors of mortality.
Methods:
The data were obtained from the Gregorio Marañon Hospital CI database. The demographic and clinical characteristics, diagnostic methods, surgical techniques employed and mortality were analysed statistically, using the chi(2) and Student t test.
Results:
One-hundred and one patients with CI were operated on between 1991 and 2006. The majority of them had cardiovascular histories and 35 cases were diagnosed during their hospital stay due to another cause. The signs and the symptoms were non-specific in 40% of the cases. Total morbidity and mortality was 39.6% and 41.6% respectively. In the post-operative IC cases, the death rate increased to 68% (p<0.01); 93% of the patients who died had transmural necrosis during the surgery (p<0.05) and 69% had a metabolic acidosis.
Conclusions:
The death rate in patients with IC that requires surgery is high, particularly if the diagnosis is made in the post-operative period after surgery for another cause, or if there is evidence of transmural necrosis during the intervention. Early diagnosis is the best tool to improve these results.
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