Segmental necrosis of ascending colon in haemodialysis patients

Abstract

A segmental necrosis of the ascending colon sometimes affecting the terminal ileum was observed 13 times in 12 end-stage renal disease patients over a 5400 patient-years observation period. In all but three cases the patient was operated within 24 h of onset of the abdominal pain. Three patients had a bowel perforation; nine had a limited intestinal necrosis. All underwent a partial resection or colectomy. Two died within 1 month. In all cases the mucosa was necrotic, the submucosa small vessels were congested and the mesenteric vessels were normal. Ischaemic bowel disease has been previously reported in uraemic patients, but our cases do not fit with the usual reported features of this complication. The absence of typical mesenteric infarction, vascular thrombosis, stenosis or major atherosclerotic lesions is surprising. The ascending colon topography of the lesions is very unusual. Ischaemia, constipation and other factors may play a role.

Non-Occlusive Mesenteric Ischemia in Chronically Dialyzed Patients: A Disease with Multiple Risk Factors

“…Most publications dealing with NOMI in the dialysis population emerged in the 1990s [1, 4, 9, 11, 12]. Undoubtedly, more elderly patients with atherosclerotic cardiovascular disease are being chronically hemodialyzed, but, on the other hand, in this era of bicarbonate-buffered dialysate and volume-controlled dialysis, the number of hypotensive episodes should be falling.…”

“…Most importantly, however, is the role of early, definitive surgery in these patients. In 1995, Charra et al [12] showed that in 9 patients operated on within 24 h after presentation, only 2 died. Similarly, Bender et al [4] had no peri-operative deaths in their 11 patients who had surgery within 24 h. Five deaths occurred in patients whose surgery was delayed.…”

“…In recent years, non-occlusive mesenteric ischemia (NOMI) has become increasingly recognized as a highly dangerous complication in both hemodialysis [1,2,3,4,5,6,7,8,9,10,11,12] and peritoneal dialysis patients, young and old alike [13,14,15]. Undoubtedly, NOMI is seen far more often in hemodialysis patients, with intradialytic hypotension being the major precipitating factor behind the development of NOMI among these patients [1, 2,4,5,6, 11].…”

Isolated cecal necrosis: our surgical experience and a review of the literature

“…For this reason, at the early stage, diagnostic laparotomy is preferable in the majority of patients, and a definitive diagnosis is made intraoperatively (22). The use of colonoscopy is also controversial in such patients, but colonoscopy has been reported to increase transmural pressure, leading to decreased colonic perfusion and increased risk of perforation (23).…”

“…In treatment, partial cecal resection or right hemicolectomy are the methods chosen according to the size of necrosis in the cecum and evidence of peritonitis (21,22). The surgical procedures performed in our series are shown in Table 2.…”