Ischemic colitis: risk factors for eventual surgery

Paterno, Flavio; McGillicuddy, Edward A.; Schuster, Kevin M.; Longo, Walter E.

doi:10.1016/j.amjsurg.2010.07.005

Cited by 48 publications

(49 citation statements)

References 13 publications

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“…Signs of systemic inflammatory response syndrome associated with distension and tenderness of the abdomen are common on clinical examination. Clinically, two distinct forms of acute presentation occur, i.e., a benign transient form that responds to clinical management and a more severe form requiring surgery [2]. The pattern of acute ischemic colitis dictates proper management and prognosis.…”

Section: Discussionmentioning

confidence: 99%

Ischemic colitis as a complication of acute myocardial infarction

Zhang¹,

Sun²,

Chong³

et al. 2015

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Ischemic colitis as a complication of acute myocardial infarction

Zhang¹,

Sun²,

Chong³

et al. 2015

International Journal of Cardiology

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“…IRIC is characterized by isolated involvement of the right colon, association with chronic renal failure, coronary artery disease, and atrial fibrillation, and a 5-fold higher requirement for surgery and a 2-fold increase in the risk of mortality compared with typical ischemic colitis. 4,22,[24][25][26] The reason for increased need for surgery and high mortality has been postulated to be the blood supply of the right colon that originates from the superior mesenteric artery and also supplies the small intestine. 4,25 Hence, concurrent or subsequent small intestinal involvement in IRIC may explain the greater need for surgery and higher mortality in IRIC.…”

Section: Discussionmentioning

confidence: 99%

“Mass-forming” Variant of Ischemic Colitis Is A Distinct Entity With Predilection for the Proximal Colon

Khor

Lauwers

Odze

et al. 2015

American Journal of Surgical Pathology

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We systematically evaluated the clinicopathologic features and outcome of a rare, unusual variant of ischemic colitis that presents as a mass lesion mimicking malignancy on imaging or colonoscopy. A retrospective search was performed for cases with a histologic diagnosis of ischemic colitis and a clinical impression of malignancy. Of the 23 patients initially identified, 4 were excluded because clinical and histologic review showed mucosal prolapse (n=1), discrete colon polyp (n=2), and a diverticular mass (n=1) without concern for malignancy. The mass-forming variant of ischemic colitis (n=19) was seen predominantly in elderly (mean age 71.8 y) women (63.2%) with a striking predilection for the right colon (13/19), particularly the cecum (n=6). Abdominal pain (52.6%) and hematochezia (26.3%) were the most common presenting symptoms. A computed tomography scan showed segmental thickening suspicious for malignancy in 6/8 patients. Colonoscopy revealed an exophytic (n=16) or stricturing (n=3) mass with a mean size of 4.67 cm. Mucosal biopsies showed features typical for ischemic colitis in all cases. A colectomy was performed in 4 cases. In 2, the mass-like appearance was due to marked submucosal and mural edema, whereas in the other 2 cases, with a malignant stricture-like lesion, marked submucosal fibrosis and cholesterol emboli were present. No malignancy was identified on follow-up in any patient (mean 39.9 mo). Follow-up colonoscopy was performed in 7 patients 1 to 32 weeks after initial presentation and showed resolution of the mass in all cases. Awareness of this rare variant of ischemic colitis will prevent unnecessary resections in these patients.

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“…4,12 Risk factors for severe disease include rightsided colonic involvement, peripheral vascular disease, atrial fibrillation, tachycardia, absence of GI bleeding, intensive care unit admission, requirement for vasopressor therapy, mechanical ventilation, intraperitoneal fluid on CT, and an increased serum L-lactate level at presentation. 12 Clear indications for immediate surgical intervention include peritonitis and pneumoperitoneum. 12 Fortunately, this patient remained hemodynamically stable in the hospital, and her symptoms resolved with conservative therapy.…”

Section: Discussionmentioning

confidence: 99%

“…12 Clear indications for immediate surgical intervention include peritonitis and pneumoperitoneum. 12 Fortunately, this patient remained hemodynamically stable in the hospital, and her symptoms resolved with conservative therapy.…”

Section: Discussionmentioning

confidence: 99%

“…12 Approximately 20% of patients with ischemic colitis have severe disease and, ultimately, require surgical intervention. 4,12 Risk factors for severe disease include rightsided colonic involvement, peripheral vascular disease, atrial fibrillation, tachycardia, absence of GI bleeding, intensive care unit admission, requirement for vasopressor therapy, mechanical ventilation, intraperitoneal fluid on CT, and an increased serum L-lactate level at presentation. 12 Clear indications for immediate surgical intervention include peritonitis and pneumoperitoneum.…”

Section: Discussionmentioning

confidence: 99%

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34-Year-Old Woman With Abdominal Pain and Blood-Streaked Diarrhea

Larsen

Nakamura

2012

Mayo Clinic Proceedings

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A 34-year-old woman presented to the emergency department for evaluation of a 12-hour history of sudden severe epigastric pain and bilateral leg weakness during exercise associated with nausea and vomiting. She experienced 2 episodes of diarrhea; 1 of which was blood streaked. The patient reported not eating or drinking much that day. She described a few previous less severe episodes of abdominal pain and diarrhea since childhood associated with certain foods. She denied fever or chills but reported a 5-lb intentional weight loss during the past month. She denied changes in her appetite, myalgia, arthralgia, or vision changes. She had no recent travel, sick contacts, or antibiotic drug use. She denied current pregnancy.The patient was previously healthy; her medical history included recurrent urinary tract infections and infertility, with a previous artificial insemination attempt resulting in a missed abortion. Current medication use includes clomiphene and progesterone vaginal suppository.At presentation, her vital signs were as follows: temperature, 36.9°C; heart rate, 69 beats/min; respiratory rate, 16 breaths/min; and blood pressure, 98/60 mm Hg. On examination, the patient appeared uncomfortable but was in no acute distress. Her abdomen was soft and nondistended, with positive bowel sounds. She had generalized tenderness in all 4 quadrants, with absence of guarding and rebound tenderness. Her mucous membranes appeared dry. Lower extremity strength was normal. Results of a urine pregnancy test obtained on arrival to the emergency department were negative.

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Ischemic colitis: risk factors for eventual surgery

Cited by 48 publications

References 13 publications

Ischemic colitis as a complication of acute myocardial infarction

Ischemic colitis as a complication of acute myocardial infarction

“Mass-forming” Variant of Ischemic Colitis Is A Distinct Entity With Predilection for the Proximal Colon

34-Year-Old Woman With Abdominal Pain and Blood-Streaked Diarrhea

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