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Related Experiment Videos

Megacolon in the elderly. Ischemic or inflammatory?

I B Margolis, R S Faro, E M Howells

    Annals of Surgery
    |July 1, 1979
    PubMed
    Summary

    A fourth form of ischemic colitis presents in the elderly with acute abdomen and colonic dilatation, often following low flow states. Early diagnosis and rectal-sparing surgery are key for better outcomes.

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    Area of Science:

    • Gastroenterology
    • Colorectal Surgery

    Background:

    • Ischemic colitis is typically described in transient, strictured, and gangrenous forms.
    • Elderly patients may present with a distinct fourth form of ischemic colitis.

    Observation:

    • This fourth form is characterized by acute abdomen, massive colonic dilatation, and systemic toxicity.
    • Bloody diarrhea can precede colonic dilatation.
    • The rectum is typically uninvolved in this condition.

    Findings:

    • Ischemia is a critical consideration in elderly patients with segmental colonic dilatation, especially after a "low flow state."
    • Barium enema can confirm segmental involvement and subsequent stricture formation.
    • Three cases of ischemic megacolon are presented, with preoperative diagnosis in only one patient.

    Implications:

    • Ischemic megacolon in the elderly has a more abrupt onset and fulminant course compared to ulcerative colitis.
    • Recovered patients exhibit a lower relapse rate than young ulcerative colitis patients.
    • Surgical management should prioritize rectal preservation; loop ileostomy and decompressive colostomy are effective temporizing measures.

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