Right-Side Colon Ischemia: Clinical Features, Large Visceral Artery Occlusion, and Long-Term Follow-Up

Longstreth, George F.; Hye, Robert J.

doi:10.7812/tpp/15-024

Cited by 8 publications

(16 citation statements)

References 31 publications

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“…The commonest symptom was abdominal pain, which was reported in 18 studies [3–6, 10–13, 16–18, 21, 23, 25–28, 32]. The nature and exact location of the abdominal pain were not elaborated upon.…”

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%

“…The second most common symptom was rectal bleeding identified in 1690/2537 (66.7%) of the patients [3, 5, 6, 10–17, 19, 21–23, 25–27]. It was found more frequently in non‐IRCI (69.9%) compared to IRCI (39.4%) and was also found more than twice as frequently in the mild colitis group (81.3%) compared to the severe colitis group (38%).…”

Section: Resultsmentioning

confidence: 99%

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

Demetriou

Nassar²,

Subramonia³

2019

World j. surg.

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“…It is thought that IRCI could be secondary to a large vessel disease and could, in fact, herald, acute mesenteric ischemia. Longstreth and Hye [3] found in their retrospective study including 49 patients with IRCI that 11.4% of them were suffering from symptomatic large visceral artery occlusion causing abdominal angina. Cardiac arrhythmia and malignancies were also frequently diagnosed during the follow-up of these patients.…”

Section: Discussionmentioning

confidence: 98%

“…In fact, the American College of Gastroenterology (ACG) guidelines strongly recommend considering the diagnosis of non-IRCI in patients with hematochezia. Compared with all other colon segments ischemia, IRCI has worse outcomes, a higher need for surgery, and a greater 30-day mortality rate [2,3]. Due to these specificities, IRCI pathophysiology has been hypothesized to be different from other IC.…”

Section: Discussionmentioning

confidence: 99%

“…Ischemic colitis (IC), the most common gastrointestinal ischemia, remains an enigmatic disease with a wide array of pathogenic mechanisms and variable outcomes [1]. Compared to left-sided colitis, isolated right colon ischemia (IRCI) has higher morbidity and mortality, it is also the most common site of mass-forming ischemic colitis [2,3]. Here, we report two cases of IRCI that present as a pseudotumor and emphasize the singularity and implications of this variant.…”

Section: Introductionmentioning

confidence: 98%

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A Rare Presentation of Isolated Right Colon Ischemia: The Mass-Forming Variant

Turki

Chakraborti

Bella

et al. 2021

Cureus

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Ischemic colitis (IC), the most common gastrointestinal ischemia, remains an enigmatic disease with a wide array of pathogenic mechanisms and injuries along with variable outcomes. Among this group, isolated right colon ischemia (IRCI) appears to be a distinct entity, with its own pathophysiology, clinical presentation, and higher morbidity and mortality compared to left-sided colitis. IRCI is the most common site of mass-forming ischemic colitis. Colonoscopy with biopsy remains the key to diagnosis for this former entity. IRCI management is the same as for other IC and complete resolution of the mass is expected within weeks.

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Right-Colon Ischemia, Acute Mesenteric Ischemia, and Vascular Imaging

Longstreth

2016

Clinical Gastroenterology and Hepatology

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1 in which they report an independent validation study of our scoring system to predict which patients with chronic diarrhea need random colonic biopsies to exclude microscopic colitis. 2 Although their study was also retrospective, because of the large amount of clinical and demographic data collected in their electronic medical records, they were able to include all patients referred with chronic diarrhea to their center during a 9-month period in 2014. We were struck by the very similar performance of the scoring system (sensitivity of 90.1% and area under the receiver operating characteristics curve of 0.67 with a cutoff 8 in their cohort versus a sensitivity of 90.5% and area under the receiver operating characteristics curve of 0.76 with the same cutoff in our own validation cohort), suggesting the scoring system may be useful in clinical practice. In our article we had proposed that the fact that we did not include all patients referred with diarrhea could have resulted in an artificially low false-positive rate, leading to a higher specificity than would be observed if the scoring system were to be applied in real time. The results of Cotter et al 1 would support this, with a lower prevalence of microscopic colitis of 13.1% (vs 16.1% in our validation cohort) and hence a specificity of 34.9% (vs 45.3% in our validation cohort).

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Right-Side Colon Ischemia: Clinical Features, Large Visceral Artery Occlusion, and Long-Term Follow-Up

Cited by 8 publications

References 31 publications

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

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

A Rare Presentation of Isolated Right Colon Ischemia: The Mass-Forming Variant

Right-Colon Ischemia, Acute Mesenteric Ischemia, and Vascular Imaging

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