Colon ischemia: Right-sided colon involvement has a different presentation, etiology and worse outcome. A large retrospective cohort study in histology proven patients

Heggeler, Lotte B. ten; Dam, Lisette J.H. van; Bijlsma, Alderina; Visschedijk, Marijn C.; Geelkerken, Robert H.; Meijssen, M. A. C.; Kolkman, Jeroen J.

doi:10.1016/j.bpg.2016.12.004

Cited by 16 publications

(17 citation statements)

References 23 publications

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“…Exclusion criteria, reported in some but not all studies, included positive stool cultures, known inflammatory bowel disease, prior abdominal aortic surgery and administration of antibiotics prior to onset of symptoms [4, 10, 11, 13, 16–18, 21, 27]. Two studies excluded patients with a history of previous colorectal or gynaecological malignancy, and two other studies excluded those who presented with large bowel obstruction [10, 11, 16].…”

Section: Resultsmentioning

confidence: 99%

“…This review has summarised the results in similar fashion. Isolated right colonic ischaemia (IRCI) was defined as endoscopic findings of ischaemic changes proximal to the hepatic flexure [11, 27]. Some studies have used the term ‘right colonic ischaemia’ which they defined as any lesion proximal to splenic flexure [4, 15, 17, 18]; others used the term ‘left colon’ but did not define it [13].…”

Section: Resultsmentioning

confidence: 99%

“…Overall 1608 out of 2153 patients (74%) from these studies complained of abdominal pain. This was more frequently evident in IRCI (71.8%) compared to non‐IRCI (46.8%) [10, 11, 26, 27]. The incidence of abdominal pain between the mild colitis group and the severe colitis group, in the five studies that grouped the patients as such, was 74.9% and 82.2%, respectively [4, 16, 18, 21, 27].…”

Section: Resultsmentioning

confidence: 99%

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The Pathophysiology, Presentation and Management of Ischaemic Colitis: A Systematic Review

Demetriou

Nassar²,

Subramonia³

2019

World j. surg.

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There are currently no guidelines on the long-term management of patients after an episode of acute ischaemic colitis. Our aim was to review the literature on the pattern of presentation and the pathophysiology of this condition and to understand the current status of the acute and long-term management of ischaemic colitis. Furthermore, we aim to provide recommendations for the clinicians in regard to the acute and long-term management of ischaemic colitis. A review of the English literature over the last 15 years was performed using Embase and Medline. Search terms were ischaemic OR ischemic, colitis OR colon. Two reviewers screened the papers against predetermined eligibility criteria. A senior consultant surgeon performed a final overview. Three hundred sixty-eight papers were identified on the initial search; 318 were irrelevant and 17 were conference abstracts; both were excluded. Thirty-three full articles were assessed for suitability; nine were further excluded. Twenty-four articles were included in the final analysis and cross-referenced against those listed in the systematic reviews. There is a large clinical heterogeneity in inclusion criteria (histological, radiological, endoscopic, surgical specimen). Twelve out of 24 articles included patients only based on histological diagnosis. The definition of right and left (or nonright) ischaemic colitis was variable based on whether hepatic or splenic flexure was used as the cut-off point. Five retrospective case series highlighted that patients with isolated right-sided ischaemic colitis had a worse prognosis than those with left-sided colitis (higher mortality, need for surgery, length of hospital stay). The overall recurrence was 9%. There is a need for a higher-level evidence to guide clinicians on the long-term management of patients following an episode of acute colonic ischaemia. Further evidence is required to determine whether right colonic ischaemia should be managed differently from left.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The Pathophysiology, Presentation and Management of Ischaemic Colitis: A Systematic Review

Demetriou

Nassar²,

Subramonia³

2019

World j. surg.

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“…The most frequently cited factors to confer an unfavourable outcome in IC are the absence of rectal bleeding15–17 and right-sided colonic involvement 4 5 15–17. Given other areas of the colon are more susceptible to ischaemic insult, right-sided involvement can be considered a marker of severity 18.…”

Section: Clinical Featuresmentioning

confidence: 99%

Ischaemic colitis: practical challenges and evidence-based recommendations for management

Hung

Calderbank

Samaan

et al. 2019

Frontline Gastroenterol

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Ischaemic colitis (IC) is a common condition with rising incidence, and in severe cases a high mortality rate. Its presentation, severity and disease behaviour can vary widely, and there exists significant heterogeneity in treatment strategies and resultant outcomes. In this article we explore practical challenges in the management of IC, and where available make evidence-based recommendations for its management based on a comprehensive review of available literature. An optimal approach to initial management requires early recognition of the diagnosis followed by prompt and appropriate investigation. Ideally, this should involve the input of both gastroenterology and surgery. CT with intravenous contrast is the imaging modality of choice. It can support clinical diagnosis, define the severity and distribution of ischaemia, and has prognostic value. In all but fulminant cases, this should be followed (within 48 hours) by lower gastrointestinal endoscopy to reach the distal-most extent of the disease, providing endoscopic (and histological) confirmation. The mainstay of medical management is conservative/supportive treatment, with bowel rest, fluid resuscitation and antibiotics. Specific laboratory, radiological and endoscopic features are recognised to correlate with more severe disease, higher rates of surgical intervention and ultimately worse outcomes. These factors should be carefully considered when deciding on the need for and timing of surgical intervention.

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“…The site of intestinal ischaemia is also a risk‐stratifier. The right side of the colon has a worse survival profile than left‐sided colonic ischaemia [ 330 , 331 , 332 ].…”

Section: Introductionmentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

et al. 2021

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Aim There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence‐based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. Methods Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology‐based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence‐based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. Results All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. Conclusion These guidelines provide an up to date and evidence‐based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.

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Colon ischemia: Right-sided colon involvement has a different presentation, etiology and worse outcome. A large retrospective cohort study in histology proven patients

Cited by 16 publications

References 23 publications

The Pathophysiology, Presentation and Management of Ischaemic Colitis: A Systematic Review

The Pathophysiology, Presentation and Management of Ischaemic Colitis: A Systematic Review

Ischaemic colitis: practical challenges and evidence-based recommendations for management

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

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