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Outcome of patients with total colonic ischemia
W E Longo1, D Ward, A M Vernava
1Department of Surgery, Saint Louis University School of Medicine, Missouri, USA.
Insights
Ischemic colitis often occurs during hospital stays or after surgery. Total colonic ischemia has a worse prognosis than segmental ischemic colitis, with higher mortality rates.
Area of Science:
- Gastroenterology
- Colorectal Surgery
Background:
- Ischemic colitis is a condition affecting the colon due to reduced blood flow.
- Understanding the outcomes of different types of ischemic colitis is crucial for patient management.
Purpose of the Study:
- To compare the outcomes of segmental ischemic colitis versus total colonic ischemia.
- To identify factors influencing patient outcomes in ischemic colitis.
Main Methods:
- A retrospective review of 43 patients diagnosed with ischemic colitis over six years.
- Patients were categorized into segmental ischemic colitis and total colonic ischemia groups.
- Data collected included demographics, symptoms, diagnosis methods, and treatment strategies.
Main Results:
- Ischemic colitis frequently developed during unrelated hospital admissions (40%) or post-surgery (14%).
- Segmental colitis (72%) had a 35% nonoperative management success rate, but surgery led to a 22% 30-day mortality.
- Total colonic ischemia (28%) universally required surgery, with a 75% mortality rate.
Conclusions:
- Ischemic colitis is a significant complication in hospitalized patients and post-surgery.
- While most segmental colitis patients can be managed nonoperatively or with stoma closure, total colonic ischemia carries a high mortality risk.
- Prompt diagnosis and appropriate management are vital for improving outcomes in ischemic colitis.
Purpose:
In this study, we sought to determine the outcome of patients with ischemic colitis, comparing patients with segmental disease with those with total colonic ischemia.
Methods:
Patients with the diagnosis of ischemic colitis over the past six years were selected and reviewed for demographics, presenting symptoms, diagnosis, and treatment.
Results:
Forty-three consecutive patients with ischemic colitis were identified and were grouped into those with segmental ischemic colitis and total colonic ischemia. Mean age was 68.8 years; 28 of 43 patients (65 percent) were males. Diagnosis was established by colonoscopy in 31 of 43 patients (72 percent), whereas in the remainder, diagnosis was made in the operating room. Ischemic colitis developed in the hospital in 17 of 43 patients (40 percent) during admission for an unrelated illness. In 6 of 43 (14 percent) of these patients, ischemic colitis developed following surgery. Thirty-one of 43 patients (72 percent) were found to have segmental colitis; 11 of 31 patients (35 percent) were successfully managed nonoperatively. Segmental colitis was present in 31 of 43 patients (72 percent), and 12 of 31 (35 percent) of these patients were successfully managed nonoperatively. In the patients with segmental colitis who required surgery, the 30-day mortality rate was 22 percent. Among 12 of 17 patients (71 percent) with segmental ischemia treated by resection and stoma, 9 of 12 (75 percent) underwent eventual stoma closure. All 12 patients with total colonic ischemia required surgery, and 9 of 12 patients (75 percent) died.
Conclusion:
Ischemic colitis occurs commonly during an unrelated hospital admission and following previous surgery. Most patients treated by resection and stoma undergo stoma closure. Total colonic ischemia carries a worse prognosis than segmental colonic ischemia.