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Ischemic colitis: clinical presentation, localization in relation to risk factors, and long-term results
Philippe M Glauser1, Petra Wermuth, Gieri Cathomas
1Department of Surgery, Hospital of Liestal (affiliated with the University of Basel), 4410, Liestal, Switzerland.
Insights
Ischemic colitis does not favor a specific colon location, often affecting multiple sites. Nonsteroidal anti-inflammatory drug (NSAID) use is linked to right-sided colon involvement. Recurrence of ischemic colitis is uncommon.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Pathology
Background:
- Ischemic colitis is often presumed to occur in the left colon near Griffith's point due to reduced blood supply.
- This study challenges that notion by investigating the actual distribution, risk factors, and outcomes.
Purpose of the Study:
- To determine the colorectal localization pattern of ischemic colitis.
- To identify risk factors associated with ischemic colitis.
- To evaluate the long-term outcomes of patients with ischemic colitis.
Main Methods:
- Retrospective analysis of 49 patients with histologically confirmed ischemic colitis diagnosed between 1996 and 2004.
- Colonoscopic assessment and pathological database review.
- Long-term follow-up of 43 patients for a median of 79 months.
Main Results:
- No significantly preferred location for ischemic colitis was found across the colorectum.
- Multiple colonic locations were affected in 55% of patients.
- Nonsteroidal anti-inflammatory drug (NSAID) use was associated with significantly more frequent involvement of the cecum, ascending colon, and right flexure.
Conclusions:
- Ischemic colitis does not have a predisposing site in the colorectum, including Griffith's point.
- The condition frequently affects multiple colonic segments.
- NSAID use correlates with right-sided colonic ischemic colitis, and recurrence appears rare.
Background:
Ischemic colitis is commonly thought to occur most often in the left hemicolon close to the splenic flexure owing to insufficient blood supply near Griffith's point. This study investigates the colorectal localization pattern, the risk factors, and the long-term outcome of histologically proven ischemic colitis.
Methods:
Between 1996 and 2004, a total of 49 patients with a median age of 69 years (range 26-94 years) with colonoscopically assessed and histologically proven ischemic colitis were identified on behalf of the pathology database. Long-term results of 43 patients were evaluated retrospectively after a median interval of 79 months (range 6-163 months).
Results:
In 27 patients (55%) more than one location was affected. We found 98 affected locations in 49 patients. The distribution of ischemic colitis in our group shows no significantly preferred location. In an exploratory analysis, the cecum, ascending colon, and right flexure were affected significantly more often if intake of a nonsteroidal antiinflammatory drug (NSAID) is documented. There was no association between the location of ischemic colitis and a history of smoking, peripheral artery occlusive disease, coronary heart disease, diabetes, or malignant tumor.
Conclusions:
Ischemic colitis seems not to have a predisposing site of occurrence in the colorectum, especially Griffith's point which was not afflicted significantly more often than other sites. Frequently, ischemic colitis afflicts more than one colonic location. In patients being treated with NSAIDs, ischemic colitis was observed significantly more often in the right hemicolon. Recurrence of ischemic colitis seems to be rare.
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