Ischemic versus non-ischemic obstructive ileocolitis secondary to colorectal cancer: a review of 393 cases

Obstructive ileocolitis, a complication of colorectal cancer, may be secondary to ischemia. We present a retrospective analysis of the long-term clinical characteristics of patients with obstructive ileocolitis caused by colorectal cancer.

A retrospective review of 363 cases of patients with obstructive ileocolitis caused by colorectal cancer.

Of 363 patients with obstruction, 56 patients had ischemic ileocolitis. There was a higher percentage of patients who presented with obstructive colitis with left-sided cancers (P = 0.0389). The majority of patients with colorectal cancer and obstructive ileocolitis had a tumor size <6 cm (P = 0.0524). Four patients had a perforation in the ischemic group as compared with only two patients in the non-ischemic group with a perforation (P = 0.0061). In the ischemic group, there were 50 patients (50/56; 89.3%) who underwent anastomosis without leakage. There were 13 patients with only segmental ischemia for which an anterior resection with anastomosis was performed. There was no statistical difference between the two groups with regards to overall morbidity or survival (P = 0.7915). However, there was a survival difference based on tumor morphology in the ischemic group with ulcerative and polypoid cancer 4.43 times more hazardous compared with annular cancer (95% CI: 1.16-12.15; P = 0.0038).

Obstructive ileocolitis occurs mostly in left-sided obstruction and there are no survival differences between the groups with and without ischemia. In addition, patients who present with colorectal cancer-induced obstructive ileocolitis may be safely treated with satisfactory outcomes.