Ischaemic colitis: Indications, extent, and results of standardized emergency surgery

Moszkowicz, David; Trésallet, Christophe; Mariani, A.; Lefèvre, Jérémie H.; Godiris-Petit, G.; Noullet, S.; Rouby, Jean‐Jacques; Ménégaux, Fabrice

doi:10.1016/j.dld.2014.02.013

Cited by 18 publications

(19 citation statements)

References 27 publications

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“…Many require intensive care admission. Table 2 demonstrates risk factors for postoperative mortality and such risk factors are understood to be additive 38 40. Based on a study of 177 patients, the Ischemic Colitis Mortality Risk score was proposed (box 1, factors in italics).…”

Section: Managementmentioning

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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Section: Managementmentioning

confidence: 99%

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

Hung

Calderbank

Samaan

et al. 2019

Frontline Gastroenterol

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“…For colonic stenosis caused by CD, surgery is often not the first choice because of the possibility of anastomotic fistula. This is also why, in our case, surgery was not adopted initially[17]. Intestinal metallic stenting is associated with a high risk of migration and difficult removal due to embedded growth of granulation tissue.…”

Section: Discussionmentioning

confidence: 97%

“…Therefore, proper perioperative management is important for reducing the risk of surgical complications[17]. The present case underwent a gradual tapering of glucocorticoid dosage and was submitted to a detailed assessment of the function of the adrenal axis.…”

Section: Discussionmentioning

confidence: 99%

Ischemic or toxic injury: A challenging diagnosis and treatment of drug-induced stenosis of the sigmoid colon

Zhang

Lin

et al. 2017

WJG

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A 48-year-old woman was admitted with 15-mo history of abdominal pain, diarrhea and hematochezia, and 5-mo history of defecation difficulty. She had been successively admitted to nine hospitals, with an initial diagnosis of inflammatory bowel disease with stenotic sigmoid colon. Findings from computed tomography virtual colonoscopy, radiography with meglumine diatrizoate, endoscopic balloon dilatation, metallic stent implantation and later overall colonoscopy, coupled with the newfound knowledge of compound Qingdai pill-taking, led to a subsequent diagnosis of ischemic or toxic bowel disease with sigmoid colon stenosis. The patient was successfully treated by laparoscopic sigmoid colectomy, and postoperative pathological examination revealed ischemic or toxic injury of the sigmoid colon, providing a final diagnosis of drug-induced sigmoid colon stenosis. This case highlights that adequate awareness of drug-induced colon stenosis has a decisive role in avoiding misdiagnosis and mistreatment. The diagnostic and therapeutic experiences learnt from this case suggest that endoscopic balloon expansion and colonic metallic stent implantation as bridge treatments were demonstrated as crucial for the differential diagnosis of benign colonic stenosis. Skillful surgical technique and appropriate perioperative management helped to ensure the safety of our patient in subsequent surgery after long-term use of glucocorticoids.

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“…Studies have shown that right colon ischemia or involvement of both right and left colon in patients with age over 50 years are associated with poor outcome 19 . Other risk factors for mortality are concomitant small bowel ischemia, chronic respiratory disease, especially chronic obstructive pulmonary disease 20,21 .…”

Section: Discussionmentioning

confidence: 99%

Ischemic colitis in a patient with chronic kidney failure: case report

Ţigliş¹,

Bologa²,

Hurmuzache³

et al. 2020

Arch Balk Med Union

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Ischaemic colitis: Indications, extent, and results of standardized emergency surgery

Cited by 18 publications

References 27 publications

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

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

Ischemic or toxic injury: A challenging diagnosis and treatment of drug-induced stenosis of the sigmoid colon

Ischemic colitis in a patient with chronic kidney failure: case report

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