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Spontaneous and shock-associated ischemic colitis

L Sakai, R Keltner, D Kaminski

    American Journal of Surgery
    |December 1, 1980
    PubMed
    Summary
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    Colonic ischemia, especially when progressing to gangrene, poses significant survival challenges. Early recognition and surgical intervention are crucial for improving outcomes in patients with ischemic colitis.

    Area of Science:

    • Gastroenterology
    • Colorectal Surgery
    • Vascular Surgery

    Background:

    • Ischemic changes in the colon leading to gangrene present diagnostic and therapeutic difficulties, often resulting in poor survival rates.
    • Colonic ischemia can manifest in two primary clinical groups: spontaneous ischemic colitis (Type I) and ischemia associated with shock (Type II).

    Purpose of the Study:

    • To analyze the clinical presentation, diagnostic correlations, and outcomes of patients treated for colonic ischemia.
    • To evaluate the impact of necrosis depth on survival rates and identify factors influencing treatment success.

    Main Methods:

    • A retrospective review of 36 patients treated for colonic ischemia over a 10-year period.
    • Correlation of radiographic findings (distended bowel) with clinical and pathological assessments of full-thickness necrosis.

    Related Experiment Videos

  • Analysis of mortality rates based on the extent of colonic necrosis (mucosal vs. full-thickness gangrene).

    • Main Results:

    • Overall mortality for colonic ischemia was 58% (21 out of 36 patients).
    • Full-thickness gangrene had a significantly higher fatality rate (71%) compared to mucosal necrosis (12% mortality, 88% survival).
    • Radiographic evidence of distended bowel correlated well with full-thickness necrosis.

    Conclusions:

    • Increased awareness, earlier surgical intervention, and judicious use of ostomies can improve treatment outcomes for colonic ischemia.
    • Distinguishing between mucosal and full-thickness necrosis is critical for predicting patient survival.
    • Prompt management is essential for patients presenting with colonic ischemia, particularly those with signs of gangrene.