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Zaffar D, Rivera E, Schwartz S, Ali O, Greenwald BD. Soccer Game Turned Bloody: A Case of Exercise-Induced Ischemic Colitis. ACG Case Rep J 2024; 11:e01406. [PMID: 38912376 PMCID: PMC11191889 DOI: 10.14309/crj.0000000000001406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/28/2024] [Indexed: 06/25/2024] Open
Abstract
Ischemic colitis (IC) should be considered as a cause for gastrointestinal symptoms in patients with recent vigorous physical activity. Vasoconstriction driven by increased sympathetic tone during exercise is believed to mediate exercise-induced IC. In this report, a 21-year-old man with no medical history developed self-resolving, sudden-onset hematochezia and abdominal pain after playing in a collegiate soccer match for 90 minutes. Colonoscopy with biopsy showed changes consistent with IC. He improved without further treatment. In most cases, exercise-induced IC resolves completely with supportive care and correction of hypovolemia. Careful monitoring is appropriate before pursuing further evaluation.
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Affiliation(s)
- Duha Zaffar
- Department of Internal Medicine, University of Maryland Medical Center Midtown, Baltimore, MD
| | | | - Stephen Schwartz
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Osman Ali
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Bruce D. Greenwald
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
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2
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Aoki T, Sadashima E, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Hayakawa Y, Fujishiro M, Kaise M, Nagata N. High risk stigmata and treatment strategy for acute lower gastrointestinal bleeding: a nationwide study in Japan. Endoscopy 2024; 56:291-301. [PMID: 38354743 DOI: 10.1055/a-2232-9630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND The rebleeding risks and outcomes of endoscopic treatment for acute lower gastrointestinal bleeding (ALGIB) may differ depending on the bleeding location, type, and etiology of stigmata of recent hemorrhage (SRH) but have yet to be fully investigated. We aimed to identify high risk endoscopic SRH and to propose an optimal endoscopic treatment strategy. METHODS We retrospectively analyzed 2699 ALGIB patients with SRH at 49 hospitals (CODE BLUE-J Study), of whom 88.6 % received endoscopic treatment. RESULTS 30-day rebleeding rates of untreated SRH significantly differed among locations (left colon 15.5 % vs. right colon 28.6 %) and etiologies (diverticular bleeding 27.5 % vs. others [e. g. ulcerative lesions or angioectasia] 8.9 %), but not among bleeding types. Endoscopic treatment reduced the overall rebleeding rate (adjusted odds ratio [AOR] 0.69; 95 %CI 0.49-0.98), and the treatment effect was significant in right-colon SRH (AOR 0.46; 95 %CI 0.29-0.72) but not in left-colon SRH. The effect was observed in both active and nonactive types, but was not statistically significant. Moreover, the effect was significant for diverticular bleeding (AOR 0.60; 95 %CI 0.41-0.88) but not for other diseases. When focusing on treatment type, the effectiveness was not significantly different between clipping and other modalities for most SRH, whereas ligation was significantly more effective than clipping in right-colon diverticular bleeding. CONCLUSIONS A population-level endoscopy dataset allowed us to identify high risk endoscopic SRH and propose a simple endoscopic treatment strategy for ALGIB. Unlike upper gastrointestinal bleeding, the rebleeding risks for ALGIB depend on colonic location, bleeding etiology, and treatment modality.
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Affiliation(s)
- Tomonori Aoki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eiji Sadashima
- Department of Medical Research Institute, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Katsumasa Kobayashi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Atsushi Yamauchi
- Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jun Omori
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke's International University, Tokyo, Japan
| | - Taiki Aoyama
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Naoyuki Tominaga
- Department of Gastroenterology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Yoshinori Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Takaaki Kishino
- Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan
| | - Naoki Ishii
- Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, Aichi, Japan
| | - Masaki Murata
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akinari Takao
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | | | - Ken Kinjo
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Shunji Fujimori
- Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Takahiro Uotani
- Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Minoru Fujita
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Hiroki Sato
- Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yoku Hayakawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitsuru Kaise
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Naoyoshi Nagata
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
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Qian W, Bruinsma J, Mac Curtain B, Ibraheem M, Temperley HC, Ng ZQ. Surgical prevalence and outcomes in ischemic colitis: A systematic review and meta-analysis. World J Surg 2024; 48:943-953. [PMID: 38441288 DOI: 10.1002/wjs.12123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/09/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND/AIM This study reviews the literature to examine the proportion of patients requiring surgical management in ischemic colitis (IC) and identify surgical outcomes. METHOD A systematic review of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials was conducted in accordance with the latest Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. English language studies and adult patients were included. Studies with fewer than 10 patients, and IC post aortic or cardiac surgery was excluded. We present our systematic review and meta-analysis with pooled proportions of right sided IC distribution and prevalence of surgical treatment. RESULTS 23 studies with a total of 12,844 patients were included in the systematic review, with 19 studies and 12,420 patients included in the meta-analysis. Four studies were excluded from the meta-analysis due to only including specific cohorts of patients-two with cocaine induced colitis, one with phlebosclerotic colitis, and one with IC associated with acute myocardial infarction. The pooled proportion of right sided IC distribution was 15% (CI 14%-17%, p < 0.001), whilst the pooled proportion of surgical management of IC was 15% (CI 13%-16% p < 0.001). CONCLUSION Prevalence of surgical management of IC is rare. Right sided IC is associated with higher mortality and higher rates of surgical management. Reporting of surgical outcomes is scant.
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Affiliation(s)
- Wanyang Qian
- Department of Surgery, St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Joshua Bruinsma
- Department of Surgery, St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Benjamin Mac Curtain
- Department of Surgery, St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Mark Ibraheem
- Department of Surgery, St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Hugo C Temperley
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zi Qin Ng
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
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Garzelli L, Ben Abdallah I, Nuzzo A, Zappa M, Corcos O, Dioguardi Burgio M, Cazals-Hatem D, Rautou PE, Vilgrain V, Calame P, Ronot M. Insights into acute mesenteric ischaemia: an up-to-date, evidence-based review from a mesenteric stroke centre unit. Br J Radiol 2023; 96:20230232. [PMID: 37493183 PMCID: PMC10607400 DOI: 10.1259/bjr.20230232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 07/27/2023] Open
Abstract
Radiologists play a central role in the diagnostic and prognostic evaluation of patients with acute mesenteric ischaemia (AMI). Unfortunately, more than half of AMI patients undergo imaging with no prior suspicion of AMI, making identifying this disease even more difficult. A confirmed diagnosis of AMI is ideally made with dynamic contrast-enhanced CT but the diagnosis may be made on portal-venous phase images in appropriate clinical settings. AMI is diagnosed on CT based on the identification of vascular impairment and bowel ischaemic injury with no other cause. Moreover, radiologists must evaluate the probability of bowel necrosis, which will influence the treatment options.AMI is usually separated into different entities: arterial, venous, non-occlusive and ischaemic colitis. Arterial AMI can be occlusive or stenotic, the dominant causes being atherothrombosis, embolism and isolated superior mesenteric artery (SMA) dissection. The main finding in the bowel is decreased wall enhancement, and necrosis can be suspected when dilatation >25 mm is identified. Venous AMI is related to superior mesenteric vein (SMV) thrombosis as a result of a thrombophilic state (acquired or inherited), local injury (cancer, inflammation or trauma) or underlying SMV insufficiency. The dominant features in the bowel are hypoattenuating wall thickening with submucosal oedema. Decreased enhancement of the involved bowel suggests necrosis. Non-occlusive mesenteric ischaemia (NOMI) is related to impaired SMA flow following global hypoperfusion associated with low-flow states. There are numerous findings in the bowel characterised by diffuse extension. An absence of bowel enhancement and a thin bowel wall suggest necrosis in NOMI. Finally, ischaemic colitis is a sub-entity of arterial AMI and reflects localised colon ischaemia-reperfusion injury. The main CT finding is a thickened colon wall with fat stranding, which seems to be unrelated to SMA or inferior mesenteric artery lesions. A precise identification and description of vascular lesions, bowel involvement and features associated with transmural necrosis is needed to determine patient treatment and outcome.
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Affiliation(s)
| | - Iannis Ben Abdallah
- Université Paris Cité, France & Service de chirurgie vasculaire, Hôpital Bichat, APHP.Nord, Paris, France
| | - Alexandre Nuzzo
- Intestinal Stroke Center, Service de gastroenterologie, MICI et Insuffisance intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Magaly Zappa
- Université des Antilles & Service de radiologie, Centre Hospitalier André Rosemon, Cayenne, France
| | - Olivier Corcos
- Intestinal Stroke Center, Service de gastroenterologie, MICI et Insuffisance intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Marco Dioguardi Burgio
- Université Paris Cité, France & Service de radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Dominique Cazals-Hatem
- Université Paris Cité, France & Service d’anatomopathologie, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Pierre-Emmanuel Rautou
- Université Paris Cité, France & Service d’hépatologie, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Valérie Vilgrain
- Université Paris Cité, France & Service de radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Paul Calame
- Université Bourgogne Franche-comté, Service de radiologie, CHU Besançon, France
| | - Maxime Ronot
- Université Paris Cité, France & Service de radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France
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5
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Jiang T, Cai Z, Mu M, Zhao Z, Shen C, Zhang B. The Global Burden of Vascular Intestinal Disorders in 204 Countries and Territories From 1990 to 2019: Global Burden of Diseases Study. Int J Public Health 2023; 68:1606297. [PMID: 37822566 PMCID: PMC10562586 DOI: 10.3389/ijph.2023.1606297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/21/2023] [Indexed: 10/13/2023] Open
Abstract
Objectives: Assess the prevalence, mortality, and disability-adjusted life years (DALYs) of vascular intestinal disorders (VID) from 1990 to 2019. Methods: This study conducted a secondary data analysis utilizing the Global Burden of Diseases Study 2019. The prevalence, mortality and DALYs of VID were analyzed by sex, age and socio-demographic index (SDI), respectively. Analyses were performed by using R software. Results: Globally, the number of prevalent VID cases increased from 100,158 (95% uncertainty interval: 89,428-114,013) in 1,990-175,740 (157,941-198,969) in 2019. However, the age-standardized rates (ASR) of VID prevalence declined from 2.47 (95% uncertainty interval: 2.24-2.76) per 100,000 population to 2.21 (1.98-2.48) per 100,000 population between 1990 and 2019. Furthermore, the ASR of mortality also decreased from 1990 to 2019. Between 1990 and 2019, the regions with high and high-middle level exhibited the highest diseases burden. Conclusion: Globally, the diseases burden associated with VID demonstrated a decline from 1990 to 2019. However, concerted efforts are still required to enhance measures to combat VID within countries categorized as high and high-middle SDI.
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Affiliation(s)
- Tianxiang Jiang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaolun Cai
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mingchun Mu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Zhao
- Department of Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Chaoyong Shen
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Zhang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Tateno K, Motegi Y, Ogawa H, Suga K, Okada T, Osone K, Katoh R, Ubukata Y, Saito H, Hara K, Sakai M, Ogata K, Sohda M, Murakami C, Shirabe K, Saeki H. Gangrenous ischemic colitis localized to the cecum: a case report. Surg Case Rep 2023; 9:9. [PMID: 36689043 PMCID: PMC9871088 DOI: 10.1186/s40792-023-01587-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/06/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Ischemic colitis affects the left colon in elderly individuals and localization on the right side, especially in the cecum, is rare. We report a case of gangrenous ischemic colitis localized in the cecum of a patient undergoing hemodialysis. CASE PRESENTATION A 73-year-old man had been undergoing hemodialysis for chronic renal failure caused by diabetic nephropathy. He experienced frequent vomiting, diarrhea, and abdominal pain. Contrast-enhanced computed tomography revealed thickening of the cecal wall, poor enhancement, dilation of the cecum, and intrahepatic portal emphysema. No obvious abnormal findings were observed in the appendix. The patient was diagnosed with cecal necrosis and ileocecal resection was performed. Histopathological examination revealed gangrenous ischemic colitis of the cecum. He was discharged 12 days after surgery without postoperative complications. CONCLUSION It is important to consider the possibility of ischemic colitis of the right colon in the event of renal failure requiring dialysis, to ensure that opportunities for surgical intervention are not missed.
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Affiliation(s)
- Kohei Tateno
- grid.256642.10000 0000 9269 4097Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Yoko Motegi
- grid.256642.10000 0000 9269 4097Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Hiroomi Ogawa
- grid.256642.10000 0000 9269 4097Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Kunihiko Suga
- grid.256642.10000 0000 9269 4097Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Takuhisa Okada
- grid.256642.10000 0000 9269 4097Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Katsuya Osone
- grid.256642.10000 0000 9269 4097Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Ryuji Katoh
- grid.256642.10000 0000 9269 4097Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Yasunari Ubukata
- grid.256642.10000 0000 9269 4097Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Hideyuki Saito
- grid.256642.10000 0000 9269 4097Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Keigo Hara
- grid.256642.10000 0000 9269 4097Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Makoto Sakai
- grid.256642.10000 0000 9269 4097Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Kyoichi Ogata
- grid.256642.10000 0000 9269 4097Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Makoto Sohda
- grid.256642.10000 0000 9269 4097Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Chiaki Murakami
- grid.256642.10000 0000 9269 4097Department of Human Pathology, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Ken Shirabe
- grid.256642.10000 0000 9269 4097Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Hiroshi Saeki
- grid.256642.10000 0000 9269 4097Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511 Japan
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Boccatonda A, D’Ardes D, Tallarico V, Vicari S, Bartoli E, Vidili G, Guagnano MT, Cocco G, Cipollone F, Schiavone C, Accogli E. Gastrointestinal Ultrasound in Emergency Setting. J Clin Med 2023; 12:jcm12030799. [PMID: 36769448 PMCID: PMC9917741 DOI: 10.3390/jcm12030799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Acute bowel diseases are responsible for more than one third of subjects who were referred to the emergency department for acute abdominal pain and gastrointestinal evaluation. Gastrointestinal ultrasound (GIUS) is often employed as the first imaging method, with a good diagnostic accuracy in the setting of acute abdomen, and it can be an optimal diagnostic strategy in young females due to the radiation exposure related to X-ray and computed tomography methods. The physician can examine the gastrointestinal system in the area with the greatest tenderness by ultrasound, thus obtaining more information and data on the pathology than the standard physical examination. In this comprehensive review, we have reported the most relevant indications and advantages to using ultrasound in the investigation of abdominal acute pain.
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Affiliation(s)
- Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Bentivoglio (BO), 40010 Bologna, Italy
- Correspondence: ; Tel.: +39-051-664-4111
| | - Damiano D’Ardes
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Viola Tallarico
- Department of Internal Medicine, Bologna University, 40138 Bologna, Italy
| | - Susanna Vicari
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Bentivoglio (BO), 40010 Bologna, Italy
| | - Elena Bartoli
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Bentivoglio (BO), 40010 Bologna, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Maria Teresa Guagnano
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Giulio Cocco
- Internistic Ultrasound Unit, SS Annunziata Hospital, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Cosima Schiavone
- Internistic Ultrasound Unit, SS Annunziata Hospital, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Esterita Accogli
- Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, 40133 Bologna, Italy
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Clinical characteristics and long-term outcomes of hospitalised patients with ischemic colitis with different degrees of haematochezia: a retrospective study. Eur J Gastroenterol Hepatol 2022; 34:823-830. [PMID: 35506923 DOI: 10.1097/meg.0000000000002386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Based on the literature, haematochezia is associated with a benign clinical course of ischaemic colitis. However, most cases in the literature presented mild haematochezia associated with ischaemic colitis. Therefore, we aimed to investigate the impact of different degrees of haematochezia on the clinical outcomes of ischaemic colitis. METHODS Patients were divided into nonhaematochezia, mild-haematochezia, and severe-haematochezia cohorts stratified by the degree of haematochezia. The clinical characteristics and prognoses were retrospectively reviewed. RESULTS Haematochezia cohort (n = 89) was associated with a lower rate of severe illness (25% vs. 52%, P = 0.001), lower rate of isolated right colon ischaemia (7% vs. 28%, P = 0.001), lower surgery rates (13% vs. 36%, P = 0.001), and shorter hospital stay (12 vs. 17 days, P < 0.001) compared with nonhaematochezia cohort (n = 50). Severe-haematochezia cohort (n = 11) had a higher frequency of severe illness (73% vs. 18%, P < 0.001), higher surgical intervention rate (55% vs. 6%, P < 0.001), higher nonsurgical complication rate, higher in-hospital mortality (45% vs. 0%, P < 0.001), and longer hospital stay (28 vs. 10 days, P = 0.001), compared with mild-haematochezia cohort (n = 78). Additionally, in-hospital mortality (45% vs. 6%, P = 0.003) and nonsurgical complication rate were higher in the severe-haematochezia than in the nonhaematochezia cohort. However, the three cohorts had comparable prognoses for long-term survival and recurrence. CONCLUSIONS Mild haematochezia was related to a benign clinical course of ischaemic colitis, while lack of haematochezia or severe haematochezia was associated with worse hospitalisation outcomes.
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9
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Frezin J, Navez J, Johnson P, Bouchard P, Drolet S. Colorectal resection in end-stage renal disease (ESRD) patients: experience from a single tertiary center. Acta Chir Belg 2022; 122:92-98. [PMID: 33496207 DOI: 10.1080/00015458.2020.1871290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND End-stage renal disease (ESRD) and renal replacement therapy (RRT) are important risk factors for post-operative morbidity and mortality but remains poorly reported in colorectal surgery. This study aims to evaluate postoperative outcomes of ESRD patients under RRT undergoing colorectal resection. METHODS All ESRD patients under RRT who underwent colorectal resection between 2006 and 2019 were retrospectively reviewed. Perioperative outcomes were analysed, such as risk factors of postoperative complications. RESULTS Forty-two patients were analysed, including 27 emergency and 15 elective surgeries. The most frequent indication was acute colonic ischemia for emergency and malignancy for elective procedures. Laparoscopic approach was used in 12 patients (29%), without difference between elective and emergency groups. Postoperative severe complications rate (including deaths) was 50% (21/42), including 56% (15/27) and 40% (6/15) in emergency and elective groups, respectively (p = .334). Anastomotic leak was observed in 3 of the 23 patients (13%) undergoing digestive anastomosis, (1 in emergency and 2 in elective groups, p = .246). The postoperative mortality rate was 29%, not significantly different between groups. The median hospital stay was 14.5 days (8-42). At univariate analysis, history of cardiac event (p = .028) and open approach (p = .040) were associated with severe complications, and ASA score >3 (p = .043), history of cardiac event (p = .001) and diabetes (p = .030) associated with mortality. CONCLUSIONS Colorectal surgery in ESRD patient exposes to high risk of morbidity and mortality, even in the elective setting, especially in patients with comorbidities like cardiac event and diabetes. Careful patient selection and closed management is required in such fragile patients.
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Affiliation(s)
- Julie Frezin
- Department of Surgery, CHU de Québec, Université de Laval, Québec, QC, Canada
- Department of General Surgery, Clinique Notre Dame de Grâce de Gosselies, Charleroi, Belgium
| | - Julie Navez
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Paryse Johnson
- Department of Surgery, CHU de Québec, Université de Laval, Québec, QC, Canada
| | - Philippe Bouchard
- Department of Surgery, CHU de Québec, Université de Laval, Québec, QC, Canada
| | - Sébastien Drolet
- Department of Surgery, CHU de Québec, Université de Laval, Québec, QC, Canada
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10
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Huang H, Wang H, Long Z, Wang M, Ding J, Peng J. Factors influencing hospital stay duration for patients with mild ischemic colitis: a retrospective study. Eur J Med Res 2022; 27:36. [PMID: 35246255 PMCID: PMC8897856 DOI: 10.1186/s40001-022-00665-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background Ischemic colitis is the most prevalent ischemic injury of the gastrointestinal tract. The majority of patients with mild ischemic colitis usually achieve complete clinical recovery shortly. However, the predictors of longer hospital stay duration are unclear. This study aimed to evaluate the predictors of hospital stay duration for patients with mild ischemic colitis. Methods We retrospectively evaluated 100 patients with mild ischemic colitis between January 2010 and December 2020 at Xiangya Hospital (a tertiary care center). The clinical characteristics and therapeutic drugs of patients who were hospitalized for ≤ 8 days and ≥ 12 days were compared. Results Of the 100 patients included, 63 (63%) were hospitalized for ≤ 8 days and 37 (37%) were hospitalized for ≥ 12 days. Patients with cerebrovascular disease (29.7% vs. 11.1%, p = 0.019) and abdominal surgical history (29.7% vs. 7.9%, p = 0.004) were more likely to be hospitalized for ≥ 12 days than for ≤ 8 days. The d-dimer levels [0.78 (0.41–1.82) vs. 0.28 (0.16–0.73), p = 0.001] and positive fecal occult blood test results (86.5% vs. 60.3%, p = 0.006) were higher in patients who were hospitalized for ≥ 12 days than in those who were hospitalized for ≤ 8 days. Probiotic use was greater in patients hospitalized for ≤ 8 days (76.2% vs. 54.1%, p = 0.022). Multivariate analysis indicated that cerebrovascular disease (odds ratio [OR] = 4.585; 95% confidence interval [CI] 1.129–18.624; p = 0.033), abdominal surgical history (OR = 4.551; 95% CI 1.060–19.546; p = 0.042), higher d-dimer levels (OR = 1.928; 95% CI 1.024–3.632; p = 0.042), and higher positive fecal occult blood test results (OR = 7.211; 95% CI 1.929–26.953; p = 0.003) were associated with longer hospital stays. Conclusion Cerebrovascular disease, abdominal surgical history, higher d-dimer levels, and higher positive fecal occult blood test results are independent and significant factors that influence longer hospital stays for patients with mild ischemic colitis. Probiotics helped reduce hospital stay in these patients.
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Affiliation(s)
- Haosu Huang
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Hanyue Wang
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Zhenpu Long
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Meng Wang
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Junjie Ding
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Jie Peng
- Department of Gastroenterology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
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11
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Vigorita V, García-Señoráns MP, Pellino G, Troncoso Pereira P, de San Ildefonso Pereira A, Moncada Iribarren E, Sánchez-Santos R, Casal Núñez JE. Ischemic colitis. Does right colon location mean worst prognosis? Cir Esp 2022; 100:74-80. [PMID: 35120849 DOI: 10.1016/j.cireng.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/08/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Most patients with ischemic colitis have a favourable evolution; nevertheless, the location in the right colon has been associated with a worse prognosis. The purpose of this study is to compare the clinical presentation and results of right colon ischemic colitis (CICD) with ischemic colitis of other colonic segments (non-CIDC). METHODS Retrospective, observational study of patients admitted to our hospital with ischemic colitis between 1993 and 2014, identified through a computerized search of ICD9 codes. They were divided into 2 groups: CICD and non-CICD. Comorbidities, clinical presentation, need for surgery, and mortality were compared. Multivariate analysis was performed using logistic regression adjusting for age and sex. Statistical significance was established at a value of P < 0.05. RESULTS A total of 204 patients were identified, 61 (30%) with CICD; 61% of CICD patients required surgery compared to 22% of non-CICD patients (P < 0.001). Differences in post-surgical mortality (32% vs 55%) and overall mortality (20% vs 15%) were not statistically significant. CICD patients had more commonly unfavourable outcomes than non-CICD patients (61% vs 25%, P < 0.001). The odds ratio (OR) for surgery was 5.28 and 4.47 for unfavourable outcomes for patients with CICD. CONCLUSIONS CICD patients have a worse prognosis than non-CICD patients, 5 times more likely to need surgery and 4 times more likely to have unfavourable outcomes.
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Affiliation(s)
- Vincenzo Vigorita
- Unidad de Cirugía Colorrectal, Hospital Álvaro Cunqueiro, Vigo, Spain
| | | | - Gianluca Pellino
- Unidad de Cirugía Colorrectal, Hospital Vall d'Hebron, Barcelona, Spain
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12
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Our Experience with Patients That Diagnosed Ischemic Colitis in Colonoscopy. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.931180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Hogan JI, Kotton CN. A Call for Caution in the Immunocompromised: Coronavirus Disease 2019 Associated With Mortality in a Vaccinated Lung Transplant Recipient. Open Forum Infect Dis 2022; 8:ofab557. [PMID: 34988243 PMCID: PMC8694205 DOI: 10.1093/ofid/ofab557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/08/2021] [Indexed: 12/29/2022] Open
Abstract
We describe a vaccinated lung transplant recipient who experienced a fatal outcome associated with coronavirus disease 2019 (COVID-19). Tocilizumab was administered. The patient exhibited clinical and radiographic evidence of colitis during the course of multiple secondary infections. This report emphasizes the need for more conservative precautions to prevent COVID-19 infection in transplant recipients.
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Affiliation(s)
- John I Hogan
- Division of Infectious Diseases and International Health, Hospital of the University of Virginia, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Camille N Kotton
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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14
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Bad blood: ischemic conditions of the large bowel. Curr Opin Gastroenterol 2022; 38:72-79. [PMID: 34871196 DOI: 10.1097/mog.0000000000000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Colon ischemia is the most common form of intestinal ischemic injury and is seen frequently in an elderly population. This disease is usually self-limited, and many causes have been identified. The recent literature has focused on estimates of prognosis, triaging appropriate level of care, and identification of optimal treatments. In this review, we will address our current understanding of colon ischemia including epidemiology, pathophysiology, segmental distribution, presentation, diagnosis, and management. RECENT FINDINGS Research has recently been focused on factors associated with poor outcome. The medical comorbidities identified include chronic obstructive pulmonary disease (COPD), hepatic cirrhosis, and chronic aspirin use. Serological markers are noninvasive tools that can triage severity. Recent studies have shown procalcitonin, C-reactive protein, D-dimer, and neutrophil counts can help predict those at greatest risk for poor outcome. The timing of colonoscopy relative to symptomatic onset also can help predict severity. Early colonoscopy allows for quicker identification of ischemic stigmata, reducing the chance of misdiagnosis and potentially unnecessary and harmful treatment. The treatment of colon ischemia has classically been conservative with antimicrobials reserved for those with moderate or severe disease. Recent retrospective analysis calls into question the utility of antibiotics in the treatment of colon ischemia, although the data is not convincing enough to advise against antimicrobial treatment in patients with severe and fulminant disease. SUMMARY It is an exciting time for research focused on colon ischemia. With an improved knowledge, awareness of associated risk factors and predictors of severity, clinicians now have enhanced clinical tools to diagnose and triage patients earlier in the disease. This should help institute prompt and appropriate therapies ultimately improving outcomes.
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15
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Ai X, Chen Y, Qian J, Zhou B, Wang Z, Zhang Y, Li A, Gong F, Pan W, Shen B, Liu S. Prediction of severity and outcomes of colon ischaemia using a novel prognostic model: a clinical multicenter study. Ann Med 2021; 53:1914-1923. [PMID: 34726101 PMCID: PMC8567865 DOI: 10.1080/07853890.2021.1990391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 09/30/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To identify risk factors of disease severity and between mild and severe colon ischaemia (CI) patients and to improve clinical outcomes, this study aimed to explore a novel scoring model. METHODS Retrospective analyses of hospital records between January 2009 and December 2019 were included. Clinical manifestations, mortality, Oakland score, laboratory tests, colonoscopy, and histopathology were collected. Risk factors of severe CI were determined by univariate and multivariate logistic regression and used for the predicting model. RESULTS A total of 203 patients with CI were included. Serum C-reactive protein (CRP) and albumin ratio (CAR) were much higher in the severe CI group compared with that of the mild CI group (3.33 ± 1.78 versus 0.68 ± 0.97, p < .001). The Oakland score was much higher in the severe CI group (12.00 ± 3.02 versus 8.77 ± 1.63, p < .001). The histopathological finding of fibrin thrombi was an independent risk factor that predicted poor outcomes (20.00% versus. 1.09%, p < .001). Patients present with CAR ≥3.33, Oakland score ≥12, and histopathological fibrin thrombi were independent risk factors. In addition, the final scoring model was 0.042 × Oakland score + 1.040 × CAR + 3.412 × fibrin thrombi, the area under the curve (AUC) was 0.960 (95% confidence interval:0.930-0.990), and the sensitivity and specificity of the novel scoring model were 95% and 92%, respectively. CONCLUSIONS The novel prognostic model was established to predict CI severity and clinical outcomes efficiently.Key messagesIn this article, we discuss the scoring model for clinical outcomes of colon ischaemia patients.In our study, the sensitivity and specificity of a novel scoring model are very high.Thus, laboratory tests (CRP albumin ratio), Oakland score, and histopathological findings (fibrin thrombi) can be assessed efficiently for colon ischaemia outcomes.
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Affiliation(s)
- Xinbo Ai
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Gastroenterology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Yuping Chen
- Department of Gastroenterology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Jiajian Qian
- Department of Pharmacy, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Bin Zhou
- Department of Pathology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Zhenjiang Wang
- Department of Gastroenterology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Yanjun Zhang
- Department of Intensive Care Unit, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Aimin Li
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Feiyue Gong
- Department of Gastroenterology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Wensheng Pan
- Department of Gastroenterology, Zhejiang Provincial Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Bo Shen
- The Inflammatory Bowel Disease Center at Columbia, Columbia University Irving Medical Center, New York, NY, USA
| | - Side Liu
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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16
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Shin MY, Moon HS, Kwon IS, Park JH, Kim JS, Kang SH, Lee ES, Kim SH, Sung JK, Lee BS, Jeong HY. Development and Validation of a Risk Scoring Model for Early Prediction of Severe Colon Ischemia. Dig Dis Sci 2021; 66:3993-4000. [PMID: 33242157 DOI: 10.1007/s10620-020-06717-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 11/10/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Colon ischemia (CI) is injury to the intestines secondary to insufficient blood flow. Its clinical severity can range from mild to life-threatening. AIMS To investigate predictive risk factors for CI and propose a scoring model for severe outcomes. METHODS We retrospectively analyzed the medical records of patients admitted to Chungnam National University Hospital from January 2010 to December 2018. CI was defined as severe when patients required surgery immediately or after initial conservative management, death occurred after hospitalization, or symptoms persisted after 2 weeks. By controlling for possible confounders from the logistic regression analysis, we obtained a new risk scoring model for the early prediction of severe CI. Furthermore, using the area under the receiver operating characteristics curve (AUROC), we assessed the accuracy of the model. RESULTS A total of 274 patients endoscopically diagnosed with CI were included, of whom 181 had severe CI. In the multivariate analysis, tachycardia, elevated C-reactive protein, Favier endoscopic classification stage ≥ 2, and history of hypertension were independently and significantly associated with severe CI. The AUROC of the model was 0.749. CONCLUSIONS This risk scoring model based on the presence of tachycardia, elevated C-reactive protein level, unfavorable endoscopic findings by Favier's classification, and the history of hypertension could be used to predict severe CI outcomes at an early stage.
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Affiliation(s)
- Min Young Shin
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hee Seok Moon
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, South Korea
| | - Jae Ho Park
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Ju Seok Kim
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Sun Hyung Kang
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Eaum Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Seok Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Jae Kyu Sung
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Byung Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hyun Yong Jeong
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
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17
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Chronic obstructive pulmonary disease is associated with worse outcomes in ischemic colitis: a nationwide retrospective study. Int J Colorectal Dis 2021; 36:2455-2461. [PMID: 33987734 DOI: 10.1007/s00384-021-03935-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ischemic colitis (IC) occurs when the blood supply of the large intestine becomes compromised. Several cardiovascular conditions, such as coronary artery disease, congestive heart failure, and atrial fibrillation, are well-established risk factors for the development of IC. The effects of pulmonary conditions, namely chronic obstructive pulmonary disease (COPD), on IC have not been well studied. AIMS Our aim was to elucidate if the presence of COPD worsened outcomes in patients with IC. METHODS Retrospective analysis of patients hospitalized with IC in 2016 was evaluated using the National Inpatient Sample database. Baseline demographic data, length of hospital stay (LOS), total hospital cost/charge, rates of colectomy, and in-hospital mortality were extracted from the database. Categorical variables were compared using the chi-square test and continuous variables were compared using the t-test. RESULTS A total of 25,035 patients with IC were identified while 4482 of these patients also had COPD. We found that IC patients with COPD had a longer LOS (5.8 days vs 4.4 days; P<0.01), higher total hospital charge ($56,682 vs $42,365; P<0.01), higher total hospital cost ($13,603 vs $10,238; P<0.01), higher mortality rate (6.5% vs 3.1%; P<0.01), and higher colectomy rate (5.1% vs 3.7%; P<0.01). CONCLUSIONS The presence of COPD portends poor outcomes in patients with IC. This was evidenced by increased risk of death and increased risk of undergoing colectomy. Given these findings, patients with COPD warrant closer observation. We advocate that COPD be considered as part of the risk assessment of patients with acute IC who need surgical intervention.
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18
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Maimone A, De Ceglie A, Siersema PD, Baron TH, Conio M. Colon ischemia: A comprehensive review. Clin Res Hepatol Gastroenterol 2021; 45:101592. [PMID: 33662779 DOI: 10.1016/j.clinre.2020.101592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023]
Abstract
The clinical and endoscopic features of colon ischemia (CI) are non-specific. CI is correctly identified at the time of presentation in only 9% of patients is. The true incidence is likely underestimated because many mild cases resolve spontaneously without medical treatment. Furthermore, since most cases of CI are transient, and no specific cause is detected they are often considered to be "idiopathic". In the setting of severe CI correct diagnosis and prompt recognition and therapy as well as identification of underlying causes are crucial for a favourable outcome. Although less severe, mild cases may present with similar symptoms, the prognosis and management are completely different and managed conservatively rather than with surgery. Unfortunately, data from most studies and current guidelines do not provide recommendations on the long-term management of CI or about the need for endoscopic follow-up to detect the development chronic, recurrent and/or ischemic colonic strictures. In this review, we focus on the definition of CI, its aetiology, and patterns of presentation. We highlight the pharmacological and/or endoscopic management as determined severity of disease that allow for improved outcomes. Prompt recognition and treatment using a multidisciplinary approach are essential for successful management of severe CI because mortality rates are significantly higher when the diagnosis is delayed.
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Affiliation(s)
- Antonella Maimone
- Department of Gastroenterology, General Hospital, Sanremo, IM, Italy
| | | | - Peter D Siersema
- Department of Gastroenterology and Hepatology (Route 763), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Massimo Conio
- Department of Gastroenterology, General Hospital, Sanremo, IM, Italy; Department of Gastroenterology, Santa Corona General Hospital, Pietra Ligure, SV, Italy.
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19
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Tin S, Lim W, Umyarova R, Arulthasan M, Daoud M. Unusual Case of Ischemic Colitis Caused by Low-Dose Sumatriptan Therapy in a Generally Healthy Patient After Strenuous Physical Activity. Cureus 2021; 13:e17125. [PMID: 34532167 PMCID: PMC8434802 DOI: 10.7759/cureus.17125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/05/2022] Open
Abstract
Ischemic colitis refers to an inflammatory condition of the large bowel caused by ischemia. It usually presents with an acute onset abdominal pain followed by hematochezia. It can occur as a result of arterial occlusion (embolic or thrombotic), venous thrombosis, or hypoperfusion of mesenteric circulation secondary to dehydration, surgery, or medications. Herein, we present an unusual case of sumatriptan-induced ischemic colitis. Sumatriptan succinate is a selective serotonin (5-hydroxytryptamine-1) receptor agonist that is usually prescribed for refractory migraine headaches. This is a 59-year-old female who presented with acute onset abdominal pain followed by bloody diarrhea after vigorous physical activities. She has a past medical history of non-specific colitis (one time, 15 years ago) and chronic migraine for which she was on low-dose sumatriptan therapy (one tab once or twice a week). On the day of the event, the patient took sumatriptan in the morning and had strenuous activities throughout the day, and overnight she developed abdominal pain. It was followed by bouts of bloody diarrhea. The colonoscopy revealed erythematous mucosa with significant ulceration and necrosis involving the distal transverse colon, splenic flexure, descending colon, and proximal colon, suggestive of ischemic colitis. Unlike previously reported cases, this patient was only on low-dose sumatriptan therapy without frequent dosing. So, her risk of ischemic colitis from triptan therapy could have been accelerated by excessive sweating and strenuous physical activities. The patient was treated with intravenous hydration, bowel rest, intravenous antibiotics, and withdrawal of sumatriptan and her condition improved within the next two to three days.
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Affiliation(s)
- Swann Tin
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - William Lim
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Rushaniya Umyarova
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Marutha Arulthasan
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Magda Daoud
- Internal Medicine/Gastroenterology, Richmond University Medical Center, Staten Island, USA
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20
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Ionescu EM, Curte AM, Olteanu AO, Preda CM, Tieranu I, Klimko A, Tieranu CG. Rare Clinical Association between Clostridioides difficile Infection and Ischemic Colitis: Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:705. [PMID: 34356986 PMCID: PMC8307989 DOI: 10.3390/medicina57070705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 01/14/2023]
Abstract
Background and Objectives: Gut microbiota plays an important role in the wellbeing of the host through different interactions between microflora constituents. In certain instances, Clostridioides difficile may pullulate, causing infection with associated colitis that may vary in terms of severity from mild disease to severe colitis, with increased associated mortality due to its complications. However, there are few literature data regarding the association between Clostridioides difficile and ischemic colitis. Case report: We report the case of a 30-year-old male patient, overweight, with impending dehydration, who presented with hematochezia and colicky abdominal pain, with positive fecal tests for the detection of Clostridioides difficile infection and endoscopic appearance suggesting ischemic colitis in the sigmoid and left colon, confirmed by computed tomography and histology. The patient was treated with oral Vancomycin, with resolution of symptoms, and was reevaluated through colonoscopy eight weeks after discharge, with endoscopic mucosal normalization and histological scarring process on biopsy samples. Conclusion: We report one of the few cases in the literature of ischemic colitis associated with Clostridioides difficile infection, with resolution of clinical, endoscopic, and histologic changes after specific treatment with oral Vancomycin suggesting a possible association between the two diseases. We also review the existing literature data regarding this comorbid association.
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Affiliation(s)
- Elena Mirela Ionescu
- Department of Gastroenterology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania; (A.O.O.); (C.G.T.)
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.M.P.); (I.T.); (A.K.)
| | - Ana-Maria Curte
- Department of Pathology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania;
| | - Andrei Ovidiu Olteanu
- Department of Gastroenterology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania; (A.O.O.); (C.G.T.)
| | - Carmen Monica Preda
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.M.P.); (I.T.); (A.K.)
- Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Ioana Tieranu
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.M.P.); (I.T.); (A.K.)
| | - Artsiom Klimko
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.M.P.); (I.T.); (A.K.)
| | - Cristian George Tieranu
- Department of Gastroenterology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania; (A.O.O.); (C.G.T.)
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.M.P.); (I.T.); (A.K.)
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Jaber A, Hemmer S, Klotz R, Ferbert T, Hensel C, Eisner C, Ryang YM, Obid P, Friedrich K, Pepke W, Akbar M. Bowel dysfunction after elective spinal surgery: etiology, diagnostics and management based on the medical literature and experience in a university hospital. DER ORTHOPADE 2021; 50:425-434. [PMID: 33185695 DOI: 10.1007/s00132-020-04034-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bowel dysfunction after spinal surgery is often underestimated and if not treated in a timely manner can lead to undesirable surgical interventions or fatal complications. The current medical literature primarily focuses on bowel dysfunction as a result of spinal injury. OBJECTIVE The purpose of this review is to explore this topic in evaluating current evidence regarding the causes of acute bowel dysfunction after elective spinal surgery, primarily the thoracolumbar spine. Since available evidence for recommendations of treatment is scarce, an interdisciplinary management approach for treatment of bowel dysfunction following spinal surgery is also formulated. MATERIAL AND METHODS An extensive literature search was carried out on PubMed. Keywords that were used in the search included bowel dysfunction, obstruction, postoperative ileus, spinal surgery, spinal fusion, constipation, opioid-induced constipation, colonic pseudo-obstruction, ischemic colitis, immobility-induced bowel changes, epidural anesthesia and diet. Relevant studies were chosen and included in the review. The treatment approach used in the spine center of a university hospital was included. RESULTS Current research mainly focuses on investigating the nature and symptomatology of chronic bowel dysfunction after spinal cord injury. Emphasis on the acute phase of bowel dysfunction in patients after elective spinal surgery is lacking. The comorbidities that exacerbate bowel dysfunction postoperatively are well-defined. There has been refinement and expansion of the pharmacological and nonpharmacological treatment that could be implemented. Enough evidence exists to provide sufficient care. CONCLUSION Management of acute bowel dysfunction after spinal surgery requires a comprehensive and individualized approach, encompassing comorbidities, behavioral changes, medications and surgery. Close supervision and timely treatment could minimize further complications. Research is required to identify patients who are at a higher risk of developing bowel dysfunction after specific spinal procedures.
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Affiliation(s)
- A Jaber
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - S Hemmer
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - R Klotz
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - T Ferbert
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - C Hensel
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - C Eisner
- Department of Anesthesiology and Critical Care Medicine, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Y M Ryang
- Department of Neurosurgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - P Obid
- Spinal Surgery and Scoliosis Centre, Asklepios Paulinen Clinic, Geisenheimer Straße 10, 65197, Wiesbaden, Germany
| | - K Friedrich
- Department of Internal Medicine IV, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - W Pepke
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - M Akbar
- MEOCLINIC GmbH, Friedrichstraße 71, 10117, Berlin, Germany.
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22
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Li S, Luo Y, Wang W, Lu J, Hu M, Sun Q, Yang X, Han J, Zhong L. A Novel Multiparameter Scoring Model for Noninvasive Early Prediction of Ischemic Colitis: A Multicenter, Retrospective, and Real-World Study. Clin Transl Gastroenterol 2021; 12:e00370. [PMID: 34106095 PMCID: PMC8189633 DOI: 10.14309/ctg.0000000000000370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 04/20/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Ischemic colitis (IC) is a common gastrointestinal ischemic disease caused by hypoperfusion or reperfusion injury. However, there are few studies on risk factors associated with poor prognoses of the disease. This study aimed to determine the predictors of poor prognoses in patients with IC and establish a prognostic scoring method with good internal and external validity for identifying severe cases in an early stage. METHODS We established a prognosis model by conducting a multicenter, retrospective study of patients hospitalized with IC between November 2008 and May 2020. Predictive power was tested using 5-fold internal cross-validation and external validation. RESULTS The following 6 factors were included in the prognostic model: neutrophil count, D-dimer level, ischemia of the distal ileum, ischemia of the hepatic flexure, ulceration, and luminal stenosis. The area under the receiver-operating characteristic curve for internal cross-validation of the prediction model was 86%, and that for external validation was 95%. During internal validation, our model correctly identified 88.08% of the patients. It was further found that patients younger than 65 years with a higher neutrophil-to-lymphocyte ratio and higher heart rate had poor prognoses. Patients aged 65 years and older with ischemia of terminal ileum, hepatic flexure, splenic flexure, and intestinal stenosis had poor prognoses. DISCUSSION Patients with ischemia in the hepatic flexure and the distal ileum, endoscopic evidence of ulcer or stenosis, higher neutrophil counts, and higher D-dimer levels have worse prognoses. This information could aid in the selection of timely and appropriate treatment.
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Affiliation(s)
- Shan Li
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Yiwei Luo
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Wei Wang
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Jinlai Lu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Miao Hu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Qinjuan Sun
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Xiaoqing Yang
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Junyi Han
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Lan Zhong
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
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Iacobellis F, Narese D, Berritto D, Brillantino A, Di Serafino M, Guerrini S, Grassi R, Scaglione M, Mazzei MA, Romano L. Large Bowel Ischemia/Infarction: How to Recognize It and Make Differential Diagnosis? A Review. Diagnostics (Basel) 2021; 11:diagnostics11060998. [PMID: 34070924 PMCID: PMC8230100 DOI: 10.3390/diagnostics11060998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022] Open
Abstract
Ischemic colitis represents the most frequent form of intestinal ischemia occurring when there is an acute impairment or chronic reduction in the colonic blood supply, resulting in mucosal ulceration, inflammation, hemorrhage and ischemic necrosis of variable severity. The clinical presentation is variable and nonspecific, so it is often misdiagnosed. The most common etiology is hypoperfusion, almost always associated with generalized atherosclerotic disease. The severity ranges from localized and transient ischemia to transmural necrosis of the bowel wall, becoming a surgical emergency, with significant associated morbidity and mortality. The diagnosis is based on clinical, laboratory suspicion and radiological, endoscopic and histopathological findings. Among the radiological tests, enhanced-CT is the diagnostic investigation of choice. It allows us to make the diagnosis in an appropriate clinical setting, and to define the entity of the ischemia. MR may be adopted in the follow-up in patients with iodine allergy or renal dysfunctions, or younger patients who should avoid radiological exposure. In the majority of cases, supportive therapy is the only required treatment. In this article we review the pathophysiology and the imaging findings of ischemic colitis.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (L.R.)
- Correspondence:
| | - Donatella Narese
- Department of Radiology, University of Campania “L. Vanvitelli”, Miraglia 2 Sq., 80138 Naples, Italy; (D.N.); (R.G.)
| | - Daniela Berritto
- Department of Radiology, Hospital “Villa Fiorita”, Appia St., km 199,00, 81043 Capua, Italy;
| | - Antonio Brillantino
- Department of Emergency Surgery, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy;
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (L.R.)
| | - Susanna Guerrini
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, Bracci St. 10, 53100 Siena, Italy;
| | - Roberta Grassi
- Department of Radiology, University of Campania “L. Vanvitelli”, Miraglia 2 Sq., 80138 Naples, Italy; (D.N.); (R.G.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Mariano Scaglione
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK;
- Teesside University School of Health and Life Sciences, Middlesbrough TS1 3BX, UK
- Department of Radiology, Pineta Grande Hospital, Domitiana St. km 30/00, 81030 Castel Volturno, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Bracci St. 10, 53100 Siena, Italy;
| | - Luigia Romano
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (L.R.)
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Secondary Amyloidosis Presenting as Ischemic Proctitis. Case Rep Gastrointest Med 2021; 2021:6663391. [PMID: 33927906 PMCID: PMC8052136 DOI: 10.1155/2021/6663391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022] Open
Abstract
A 49-year-old man presented with abdominal pain and rectal bleeding for two days associated with a 50-pound unintentional weight loss. History was notable for hypertension, chronic kidney disease, obesity, gout, and acute cholecystitis status post cholecystectomy. Computed tomography (CT) of the abdomen and pelvis showed rectal wall thickening. Colonoscopy showed proctitis with superficial ulcerations. In the setting of renal insufficiency, malabsorption, and low-voltage QRS complexes on electrocardiogram (ECG), amyloidosis was considered in the differential diagnosis. Rectal and renal biopsies with subsequent retrospective staining of gallbladder tissue confirmed amyloid deposition. Gastrointestinal involvement of amyloidosis is relatively uncommon. Particularly, amyloid deposition in the gallbladder and rectum is very rare. The development of AA amyloidosis in our patient may have been related to gout, obesity, and the presence of a heterozygous complex variant for the MEFV (familial Mediterranean fever) gene. Awareness of this atypical presentation of amyloidosis is important, as additional staining of biopsy samples is necessary, and diagnosis allows for directed treatment.
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Yoshida T, Ichikawa N, Homma S, Yoshida T, Emoto S, Miyaoka Y, Matsui H, Taketomi A. Ischemic proctitis 6 months after laparoscopic sigmoidectomy: a case report. Surg Case Rep 2021; 7:54. [PMID: 33616775 PMCID: PMC7900365 DOI: 10.1186/s40792-021-01133-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/05/2021] [Indexed: 11/20/2022] Open
Abstract
Background Ischemic colitis is a common disease; however, its pathophysiology remains unclear, especially in ischemic proctitis after sigmoidectomy. We present a rare case of ischemic proctitis 6 months after laparoscopic sigmoidectomy. Case presentation The patient was a 60-year-old man with hypertension, type 2 diabetes, and hyperlipidemia. He was a smoker. He underwent laparoscopic sigmoidectomy for pathological stage I sigmoid colon cancer and was followed up without any adjuvant therapy. Six months after his surgery, he complained of lower abdominal discomfort, bloody stools, and tenesmus. Colonoscopy showed extensive rectal ulcers between the anastomotic site and the anal canal, which was particularly severe on the anal side several centimeters beyond the anastomosis. We provided non-surgical management, including hyperbaric oxygen therapy. The rectal ulcers had healed 48 days after the therapeutic intervention. He has not experienced any recurrence for 3.5 years. Conclusions While performing sigmoidectomy, it is important to consider the blood backflow from the anal side of the bowel carefully, especially for patients with risk factors of ischemic proctitis.
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Affiliation(s)
- Takuto Yoshida
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan
| | - Nobuki Ichikawa
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan.
| | - Shigenori Homma
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan
| | - Tadashi Yoshida
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan
| | - Shin Emoto
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan
| | - Yoichi Miyaoka
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan
| | - Hiroki Matsui
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan
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Turki M, Chakraborti A, Bella S, Hila A, Timsar A. A Rare Presentation of Isolated Right Colon Ischemia: The Mass-Forming Variant. Cureus 2021; 13:e13028. [PMID: 33680584 PMCID: PMC7924967 DOI: 10.7759/cureus.13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
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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Affiliation(s)
- M'hamed Turki
- Internal Medicine, United Health Services, Johnson City, USA
| | - Anumita Chakraborti
- Gastroenterology and Hepatology, State University of New York (SUNY) Upstate Medical University, Syracuse, USA
| | - Saif Bella
- Gastroenterology and Hepatology, United Health Services, Johnson City, USA
| | - Amine Hila
- Gastroenterology and Hepatology, United Health Services, Johnson City, USA
| | - Ali Timsar
- Pathology, United Health Services, Johnson City, USA
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Vigorita V, Paniagua García-Señoráns M, Pellino G, Troncoso Pereira P, de San Ildefonso Pereira A, Moncada Iribarren E, Sánchez-Santos R, Casal Núñez JE. Ischemic colitis. Does right colon location mean worst prognosis? Cir Esp 2021; 100:S0009-739X(20)30404-8. [PMID: 33485610 DOI: 10.1016/j.ciresp.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Most patients with ischemic colitis have a favourable evolution; nevertheless, the location in the right colon has been associated with a worse prognosis. The purpose of this study is to compare the clinical presentation and results of right colon ischemic colitis (CICD) with ischemic colitis of other colonic segments (non-CIDC). METHODS Retrospective, observational study of patients admitted to our hospital with ischemic colitis between 1993 and 2014, identified through a computerized search of the ICD9 codes. They were divided into 2groups: CICD and non-CICD. Comorbidities, clinical presentation, need for surgery, and mortality were compared. Multivariate analysis was performed using logistic regression adjusting for age and sex. Statistical significance was established at a value of P <0.05. RESULTS A total of 204 patients were identified, 61 (30%) with CICD; 61% of CICD patients required surgery compared to 22% of non-CICD patients (P <0.001). Post-surgical mortality (32 vs. 55%) and overall mortality (20 vs. 15%) differences were not statistically significant. CICD patients had more commonly unfavourable outcomes than non-CICD patients (61 vs. 25%, P <0.001). The odds ratio (OR) for surgery was 5.28 and 4.47 for unfavourable outcomes for patients with CICD. CONCLUSIONS CICD patients have a worse prognosis than non-CICD patients, 5 times more likely to need surgery and 4 times more likely to have unfavourable outcomes.
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Affiliation(s)
- Vincenzo Vigorita
- Unidad de Cirugía Colorrectal, Hospital Álvaro Cunqueiro, Vigo, España
| | | | - Gianluca Pellino
- Unidad de Cirugía Colorrectal, Hospital Vall d'Hebron, Barcelona, España
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Xu Y, Xiong L, Li Y, Jiang X, Xiong Z. Diagnostic methods and drug therapies in patients with ischemic colitis. Int J Colorectal Dis 2021; 36:47-56. [PMID: 32936393 PMCID: PMC7493065 DOI: 10.1007/s00384-020-03739-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Ischemic colitis (IC) is the most prevalent ischemic injury of thegastrointestinal tract. Clinical features of IC such as acute abdominal pain, hematochezia,and diarrhea are similar to those of acute mesenteric ischemia, inflammatorybowel disease, or infectious bowel disease, and their relative ambiguity candelay diagnosis and treatment. To comprehensively detail the current state ofdiagnostic methods and available drug therapies for detecting and treating IC,this review aims to provide a concise and practical summary of thecorresponding literature. METHODS PubMed and Cochrane Library were searched toretrieve all published studies reporting the diagnostic methods and drugtherapies in patients with ischemic colitis. The search strategy of drugtherapy includes human and animal data. RESULTS Colonoscopy combined with histopathologicalbiopsy is the standard of diagnosis for the IC. Most patients respond well tothe conservative treatment, and surgical consultation is needed when conservativetreatment is ineffective. Studies of potential drug therapy have beendeveloped, including phosphodiesterase type 5 inhibitors, pentoxifylline,rebamipide, prostaglandin E1, and polydeoxyribonucleotide. CONCLUSION Accurate diagnoses and effective treatmentshave helped reduce the mortality rate and improve prognoses for patientsafflicted with IC, and corresponding drug therapies have been constantlyupdated as new research has emerged.
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Affiliation(s)
- YuShuang Xu
- Division of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, YanHu Avenue & (027)86793043, Wuhan, 430077, Hubei, China
- Institute of Geriatrics of Hubei Province, YanHu Avenue & (027)86785587, Wuhan, 430077, Hubei, China
| | - LiNa Xiong
- Division of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, YanHu Avenue & (027)86793043, Wuhan, 430077, Hubei, China
| | - YaNan Li
- Division of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, YanHu Avenue & (027)86793043, Wuhan, 430077, Hubei, China
- Institute of Geriatrics of Hubei Province, YanHu Avenue & (027)86785587, Wuhan, 430077, Hubei, China
| | - Xin Jiang
- Division of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, YanHu Avenue & (027)86793043, Wuhan, 430077, Hubei, China
| | - ZhiFan Xiong
- Division of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, YanHu Avenue & (027)86793043, Wuhan, 430077, Hubei, China.
- Institute of Geriatrics of Hubei Province, YanHu Avenue & (027)86785587, Wuhan, 430077, Hubei, China.
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Milluzzo SM, Correale L, Marco GD, Antonelli G, Cesaro P, Olivari N, Terragnoli P, Sabatini T, Hassan C, Spada C. Leukocytes and creatinine may predict severity and guide management of ischemic colitis. Ann Gastroenterol 2021; 34:202-207. [PMID: 33654360 PMCID: PMC7903565 DOI: 10.20524/aog.2021.0577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Ischemic colitis (IC) is caused by a transient hypo-perfusion of the colon leading to mucosal ulcerations, inflammation, and hemorrhage. The primary aim was to identify predictive factors of endoscopic severity of IC. Secondary endpoints were to show epidemiology, clinical presentation, endoscopic findings, and outcomes of IC. METHODS In this single-center retrospective analysis, IC was scored according to endoscopy as: grade 1 (hyperemia, <1 cm erosions and non-confluent ulcers); grade 2 (>1 cm superficial, partially confluent ulcers); and grade 3 (deep or diffuse ulcers or necrosis). Then, IC was grouped into low- (grade 1) and high-grade (grades 2 and 3). Significant (P≤0.1) independent factor of severe IC at univariate analysis were entered into multivariate analysis and considered significant at P<0.05. RESULTS 227 patients (male:female 60:167; mean age 72.7±16.2 years) were included. IC was scored as grade 1 in 137/227 (60.4%), grade 2 in 62/227 (27.3%), and grade 3 in 28/227 (12.3%) patients. At univariate analysis, age (74.9 vs. 71.3 years; P=0.09), diabetes (14.4% vs. 12.4%; P=0.09), and leukocytosis or creatinine elevation (74.4% vs. 60.6%; P=0.032) were associated with endoscopic high-grade IC. At multivariate analysis, leukocytosis and creatinine levels remained associated with high-grade IC (44.7% vs. 29.9%; odds ratio 1.92, 95% confidence interval 1.07-3.52; P=0.030). CONCLUSIONS Although confounding factors cannot be excluded due to study design and patients' characteristics, leukocytosis and/or creatinine elevation at hospital admission were significantly related with endoscopic high-grade IC and might be used to stratify patients for the need of endoscopy.
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Affiliation(s)
- Sebastian Manuel Milluzzo
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (Sebastian Manuel Milluzzo, Paola Cesaro, Nicola Olivari, Tony Sabatini, Cristiano Spada)
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS -Università Cattolica del Sacro Cuore, Rome (Sebastian Manuel Milluzzo, Cristiano Spada)
- Correspondence to: Sebastian Manuel Milluzzo, MD, Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Via L. Bissolati, 57, 25125 Brescia, Italy, e-mail:
| | - Loredana Correale
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome (Loredana Correale, Giulio Antonelli, Cesare Hassan)
| | - Guido De Marco
- Emergency Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (Guido De Marco, Paolo Terragnoli), Italy
| | - Giulio Antonelli
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome (Loredana Correale, Giulio Antonelli, Cesare Hassan)
| | - Paola Cesaro
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (Sebastian Manuel Milluzzo, Paola Cesaro, Nicola Olivari, Tony Sabatini, Cristiano Spada)
| | - Nicola Olivari
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (Sebastian Manuel Milluzzo, Paola Cesaro, Nicola Olivari, Tony Sabatini, Cristiano Spada)
| | - Paolo Terragnoli
- Emergency Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (Guido De Marco, Paolo Terragnoli), Italy
| | - Tony Sabatini
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (Sebastian Manuel Milluzzo, Paola Cesaro, Nicola Olivari, Tony Sabatini, Cristiano Spada)
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome (Loredana Correale, Giulio Antonelli, Cesare Hassan)
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (Sebastian Manuel Milluzzo, Paola Cesaro, Nicola Olivari, Tony Sabatini, Cristiano Spada)
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS -Università Cattolica del Sacro Cuore, Rome (Sebastian Manuel Milluzzo, Cristiano Spada)
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30
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Hollerweger A, Maconi G, Ripolles T, Nylund K, Higginson A, Serra C, Dietrich CF, Dirks K, Gilja OH. Gastrointestinal Ultrasound (GIUS) in Intestinal Emergencies - An EFSUMB Position Paper. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:646-657. [PMID: 32311749 DOI: 10.1055/a-1147-1295] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
An interdisciplinary group of European experts summarizes the value of gastrointestinal ultrasound (GIUS) in the management of three time-critical causes of acute abdomen: bowel obstruction, gastrointestinal perforation and acute ischemic bowel disease. Based on an extensive literature review, statements for a targeted diagnostic strategy in these intestinal emergencies are presented. GIUS is best established in case of small bowel obstruction. Metanalyses and prospective studies showed a sensitivity and specificity comparable to that of computed tomography (CT) and superior to plain X-ray. GIUS may save time and radiation exposure and has the advantage of displaying bowel function directly. Gastrointestinal perforation is more challenging for less experienced investigators. Although GIUS in experienced hands has a relatively high sensitivity to establish a correct diagnosis, CT is the most sensitive method in this situation. The spectrum of intestinal ischemia ranges from self-limited ischemic colitis to fatal intestinal infarction. In acute arterial mesenteric ischemia, GIUS may provide information, but prompt CT angiography is the gold standard. On the other end of the spectrum, ischemic colitis shows typical ultrasound features that allow correct diagnosis. GIUS here has a diagnostic performance similar to CT and helps to differentiate mild from severe ischemic colitis.
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Affiliation(s)
- Alois Hollerweger
- Department of Radiology, Hospital Barmherzige Brüder, Salzburg, Austria
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, "L.Sacco" University Hospital, Milan, Italy
| | - Tomas Ripolles
- Department of Radiology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Kim Nylund
- Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - Antony Higginson
- Department of Radiology, Queen-Alexandra-Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom of Great Britain and Northern Ireland
| | - Carla Serra
- Internal Medicine and Gastroenterology, S. Orsola University Hospital, Bologna, Italy
| | - Christoph F Dietrich
- Department of General Internal Medicine Kliniken Hirslanden Beau-Site, Salem und Permanence, Bern, Switzerland
| | - Klaus Dirks
- Gastroenterology and Internal Medicine, Rems-Murr-Klinikum Winnenden, Germany
| | - Odd Helge Gilja
- Haukeland University Hospital, National Centre for Ultrasound in Gastroenterology, Bergen, Norway
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Peritoneal dialysis-related peritonitis complicated with nonocclusive mesenteric ischemia. CEN Case Rep 2020; 10:74-77. [PMID: 32865709 DOI: 10.1007/s13730-020-00522-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022] Open
Abstract
Peritoneal dialysis (PD)-related peritonitis is a common complication of PD. Nonocclusive mesenteric ischemia (NOMI) is a rare complication of PD-related peritonitis, has a high mortality rate, and therefore should be detected early once it occurs. We describe a case of a 70-year-old woman on PD presented with moderate abdominal pain and low blood pressure, which contributed to the early diagnosis of PD-related peritonitis complicated with NOMI. Increased white cell count of 7150/μL (neutrophil, 84%) in dialysate effluent was diagnostic of PD-related peritonitis, which was later found to be caused by Pseudomonas putida. Computed tomography with contrast performed after administering crystalloids revealed hepatic portal venous gas, pneumatosis intestinalis in the ascending colon, and normal enhancement of the bowel wall and mesenteric arteries, which suggested a reperfusion of the previously ischemic ascending colon. Colonoscopy on hospital day seventeen revealed mucosal hemorrhage and ulcers in the entire right colon and the terminal ileum while the remaining colon was normal. These findings are compatible with the consequence of NOMI. Increased peak systolic velocity of the superior mesenteric artery (SMA) implied its stenosis. Past studies show that ischemia of the colon in patients with chronic kidney disease commonly occurs in the right colon. Arteriosclerosis of the SMA due to the long history of chronic kidney disease and diabetes might have caused its vulnerability to low blood pressure. Abdominal complications including NOMI should be screened for when a patient presents with low blood pressure and strong abdominal pain. This is the first case report that shows colonoscopy images of the colonic ulcers post-NOMI and PD-related peritonitis.
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Liaquat H, Zanders TB, Bratis LE, Stoll LM, Chaput KJ. Ischemic Colitis in a Patient on Venovenous Extracorporeal Membrane Oxygenation (VV-ECMO) Treatment: An Emerging Complication? AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923374. [PMID: 32737281 PMCID: PMC7423171 DOI: 10.12659/ajcr.923374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patient: Male, 48-year-old Final Diagnosis: Ischemic colitis Symptoms: Hematochezia Medication:— Clinical Procedure: Colonoscopy Specialty: Critical Care Medicine • Gastroenterology and Hepatology
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Affiliation(s)
- Hammad Liaquat
- Department of Gastroenterology, St Luke's University Health Network, Bethlehem, PA, USA
| | - Thomas B Zanders
- Department of Pulmonary and Critical Care Medicine, St Luke's University Health Network, Bethlehem, PA, USA
| | - Livia E Bratis
- Department of Pulmonary and Critical Care Medicine, St Luke's University Health Network, Bethlehem, PA, USA
| | - Lisa M Stoll
- Department of Pathology, St Luke's University Health Network, Bethlehem, PA, USA
| | - Kimberly J Chaput
- Department of Gastroenterology, St Luke's University Health Network, Bethlehem, PA, USA
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The Uncertain Effect of Antimicrobial Therapy in the Treatment of Patients with Ischemic Colitis. J Clin Med 2020; 9:jcm9072182. [PMID: 32664298 PMCID: PMC7408655 DOI: 10.3390/jcm9072182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/30/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022] Open
Abstract
Although antimicrobial therapy is recommended for patients with moderate or severe ischemic colitis, its beneficial effects are unclear. In the present study, the role of antimicrobial therapy in the treatment of ischemic colitis was investigated. Patients with ischemic colitis were retrospectively identified between January 2004 and June 2019. The characteristics and outcomes of patients who received antibiotics (antibiotics group) and those who did not (no-antibiotics group) were compared. Clinical outcomes included death, surgery, and readmission within 30 days, fasting duration, and hospital stay. Data from 186 patients were analyzed; 122 patients were in the antibiotics group and 64 in the no-antibiotics group. Composite outcome of death, surgery, and readmission within 30 days occurred in 3.3% of patients in the antibiotics group and 3.1% of patients in the no-antibiotics group (p > 0.999). Fasting duration was not significantly different between the two groups (median days, 4.0 vs. 4.0, p = 0.253). However, hospital stays were longer in the antibiotics group than in the no-antibiotics group (median days, 9.0 vs. 7.0, p = 0.043). In patients with ischemic colitis, there was no statistically significant difference in the incidence of death, surgery, and readmission within 30 days between patients who received antibiotics and those who did not receive antibiotics.
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Abstract
The purpose of this study was to identify risk factors predictive of severe nonocclussive ischemic colitis (IC) requiring operation or resulting in mortality. One hundred seventeen patients with nonocclussive IC were identified and divided into two groups: those with severe disease (n = 24) and those with disease that resolved with supportive care (n = 93). Univariate and multivariate logistic regression models were used. The splenic flexure was the most common involved segment (57.3%), whereas the right colon was involved in 17.9 per cent of patients. Multivariate logistic regression identified three independent risk factors for severe disease: leukocytosis greater than 15 3 109/L (odds ratio [OR], 5.7; confidence interval [CI], 1.5 to 21), hematocrit less than 35 per cent (OR, 4.5; CI, 1.1 to 17), and history of atrial fibrillation (OR, 15; CI, 1.3 to 190). Right-sided IC and chronic renal insufficiency did not affect severity. Special attention should be given to patients with the following risk factors for a severe course: atrial fibrillation, elevated white blood cell count, and anemia. These factors might enable earlier identification of patients who may benefit from early operation. Further prospective studies focusing on subgroups of IC (occlusive and nonocclusive) are required.
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Byrnes K, Khararjian A, Mannan AASR, Arnold M, Voltaggio L. Young-Onset Ischemic Colitis: A Condition of Elusive Etiology Frequently Associated With Immune Dysregulation. Int J Surg Pathol 2019; 28:361-366. [PMID: 31870209 DOI: 10.1177/1066896919894671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Ischemic colitis (IC) associates with older age, hypertension, and heart disease, among others. Young-onset IC is rare. We aimed to delineate clinical characteristics of young patients (<40 years) with IC. Cases from 1984 to 2017 were re-reviewed. Of the 60 cases available, 52% (n = 31) had histologic features of IC. Fifty-five percent were female with a mean age of 32 (range = 14-40) years. Fifty-eight percent (n = 18) were resections. The most common presentations were diarrhea and abdominal pain. Three teenagers had IC associated with prior surgery, volvulus, and constipation. In the 21- to 40-year group, 43% (n = 12) lacked clinical associations. A second subset (n = 6, 21%) had histories of immune dysregulation (lupus, dermatomyositis, vasculitis) and poorly controlled HIV/AIDS (n = 5, 18%). Smoking and cocaine were endorsed by 1 and 2 patients, respectively. One patient had premature atherosclerosis while another had HMG Co-A lyase deficiency. Vasculitis was identified in 22% of the resections and in none of the biopsies. Nineteen percent of patients died (n = 6) from complications of IC, all treated surgically, including 1 patient previously misdiagnosed as ulcerative colitis; 2 patients died of unrelated causes. While rare before 20 years of age, IC in teenagers relates to mechanical issues and is rare in children. Associations in young adults include immune dysregulation, cocaine and cigarette use, and premature atherosclerosis. Our retrospective cohort had a surgical mortality rate within the range reported by others, highlighting the importance of accurate diagnosis in young individuals.
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Acute vascular insufficiency of intestine: incidence highest in summer, outcomes worst in winter. Int J Colorectal Dis 2019; 34:2059-2067. [PMID: 31707559 DOI: 10.1007/s00384-019-03421-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The incidence of acute vascular insufficiency of intestine (AVII) is on the rise in the USA and is associated with significant morbidity and mortality. Seasonal variations have been observed in the onset of several gastrointestinal diseases. It is thus far unknown whether the incidence, in-hospital mortality rates, and length of hospital stay (LOS) of AVII vary in different seasons. AIMS The aims of this study were to study the seasonal variations in the (1) incidence, (2) in-hospital mortality, and (3) LOS of AVII in the USA. METHODS We used the Nationwide Inpatient Sample to identify patients aged ≥ 18 years hospitalized from the years 2000-2014. We used the Edwards recognition with estimation of cyclic trend method to study the seasonal variation of AVII hospitalizations and z test to compare the seasonal incidences (peak-to-low ratio), mortalities, and LOS. RESULTS A total of 1,441,447 patients were hospitalized with AVII (0.3% of all hospitalizations). Patients with AVII were older (69.0 ± 0.1 vs 56.9 ± 0.1) and more commonly females (65.4% vs 35.5%) than patients without AVII (p < 0.001). The incidence of AVII increased through the summer to peak in September (peak/low ratio 1.028, 95% CI 1.024-1.033, p < 0.001). Patients with AVII hospitalized in winter had the highest mortality (17.3%, p < 0.001) and LOS (9.2 ± 0.7 days, p < 0.001). CONCLUSIONS The incidence of AVII in the USA peaks in late summer. The in-hospital mortality rates and LOS associated with AVII are the highest in winter. Physicians could be cognizant of the seasonal variations in the incidence, in-hospital mortality, and LOS of AVII.
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37
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Lechner S, Keyashian K. Mass Transition: From Cecal Mass to Small Bowel Ischemia. Dig Dis Sci 2019; 64:3436-3439. [PMID: 31292782 DOI: 10.1007/s10620-019-05726-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Sarah Lechner
- Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Kian Keyashian
- Stanford University School of Medicine, Stanford, CA, 94305, USA
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The Pathophysiology, Presentation and Management of Ischaemic Colitis: A Systematic Review. World J Surg 2019; 44:927-938. [DOI: 10.1007/s00268-019-05248-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Chan NHHL, Rafiee H, Beales ILP, Karthigan R, Ciorra A, Kim T. Isolated caecal necrosis-a case study. BJR Case Rep 2019; 5:20180089. [PMID: 31501701 DOI: 10.1259/bjrcr.20180089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 11/05/2022] Open
Abstract
A patient with right iliac fossa pain underwent CT angiography which demonstrated isolated caecal necrosis with associated superior mesenteric artery (SMA) stenosis. This was supported by colonoscopic findings and histopathological analysis. Isolated caecal necrosis is a rare presentation of ischaemic colitis.. Clinical and imaging findings of ischaemic colitis may mimic other pathologies. To improve diagnostic accuracy both referrers and radiologists should be aware of risk factors associated with ischaemic colitis. Isolated bowel wall thickening and pneumatosis of a colonic segment on CT are suggestive of focal bowel ischaemia, in the right clinical context.
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Affiliation(s)
| | - Hameed Rafiee
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Ian L P Beales
- Department of Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Ravindran Karthigan
- Department of Radiology, Colchester Hospital University NHS Foundation Trust, Essex, UK
| | - Annabel Ciorra
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Taeyang Kim
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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40
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McDonald NM, Piovezani Ramos G, Sweetser S. 60-Year-Old Man With Syncope, Abdominal Pain, and Hematochezia. Mayo Clin Proc 2019; 94:1883-1887. [PMID: 31400905 DOI: 10.1016/j.mayocp.2019.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/26/2018] [Accepted: 01/08/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Nicholas M McDonald
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | | | - Seth Sweetser
- Advisor to Residents and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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41
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Akanbi O, Adejumo AC. Early Endoscopy Is Associated with Better Clinical Outcomes in Patients Hospitalized with Ischemic Bowel Disease. Dig Dis Sci 2019; 64:2467-2477. [PMID: 30929115 DOI: 10.1007/s10620-019-05598-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 03/21/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Providing diagnostic and therapeutic interventions, lower gastrointestinal endoscopy is a salient investigative modality for ischemic bowel disease (IB). As studies on the role of endoscopic timing on the outcomes of IB are lacking, we sought to clarify this association. METHODS After identifying 18-to-90-year-old patients with a primary diagnosis of IB from the 2012-2014 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, we grouped them based on timing of endoscopy into three: early (n = 9268), late (n = 3515), and no endoscopy (n = 18,452). We explored the determinants of receiving early endoscopy, the impact of endoscopic timing on outcomes (mortality and 13 others), and the impact of the type of endoscopy (colonoscopy vs. sigmoidoscopy) on these outcomes among the early group (SAS 9.4). RESULTS Less likely to receive early endoscopy were Blacks compared to Whites (adjusted odds ratio [aOR] 0.81 95% CI [0.70-0.94]), and individuals on Medicaid, Medicare, and uninsured compared to the privately insured group (aOR 0.80 [0.71-0.91], 0.70 [0.58-0.84], and 0.68 [0.56-0.83]). Compared to the late and no endoscopy groups, patients with early endoscopy had less mortality (aOR 0.53 [0.35-0.80] and 0.09 [0.07-0.12]), shorter length of stay (LOS, 4.64 [4.43-4.87] days vs. 8.87 [8.40-9.37] and 6.62 [6.52-7.13] days), lower total hospital cost (THC, $41,055 [$37,995-$44,361] vs. $72,598 [$66,768-$78,937] and $68,737 [$64,028-$73,793]), and better outcomes. Similarly, among those who received early endoscopy, colonoscopy had better outcomes than sigmoidoscopy for mortality, THC, LOS, and adverse events. CONCLUSION Early endoscopy, especially colonoscopy, is associated with better clinical outcomes and decreased healthcare utilization in IB. Unfortunately, there are disparities against Blacks, and non-privately insured individuals in receiving early endoscopy.
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Affiliation(s)
- Olalekan Akanbi
- Division of Hospital Medicine, Department of Medicine, University of Kentucky College of Medicine, Lexington, KY, USA.
| | - Adeyinka Charles Adejumo
- Department of Medicine, North Shore Medical Center, Salem, MA, USA
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Clinical Features and Outcomes of Patients With Acute Mesenteric Ischemia and Concomitant Colon Ischemia: A Retrospective Cohort Study. J Surg Res 2019; 233:231-239. [DOI: 10.1016/j.jss.2018.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 07/16/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022]
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43
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Fenster M, Feuerstadt P, Brandt LJ, Mansoor MS, Huisman T, Aroniadis OC. Real-world multicentre experience of the pathological features of colonic ischaemia and their relationship to symptom duration, disease distribution and clinical outcome. Colorectal Dis 2018; 20:1132-1141. [PMID: 29969179 DOI: 10.1111/codi.14323] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/06/2018] [Indexed: 02/08/2023]
Abstract
AIM To determine the pathological features of colonic ischaemia (CI) and their relationship to symptom duration, disease distribution and clinical outcome in a real-world, clinical setting. METHOD A retrospective, multicentre chart review was performed in patients diagnosed with CI at Montefiore Medical Center (January 2005 to July 2015), and Yale-New Haven Hospital (January 2005 to June 2010). Patients were included if clinical presentation, colonoscopic findings and colonic pathology were all consistent with CI. RESULTS Six hundred and sixteen patients with pathologically proven CI were included. Common pathological findings included inflammation (51.1%), ulceration (38.2%), fibrosis (26.0%) and necrosis (20.4%). Infarction and ghost cells were seen in 1.6% and 0.2% of cases, respectively. There was a significant relationship between symptom duration and hyalinization of the lamina propria (P = 0.05) and cryptitis/crypt abscesses (P = 0.01). Patients with isolated right CI (IRCI) were more likely than patients with isolated left CI (ILCI) to exhibit necrosis (P < 0.01), cryptitis/crypt abscess (P < 0.01) and inflammation (P = 0.03). Patients with poor outcomes were more likely to exhibit necrosis (P < 0.01) and capillary fibrin thrombi (P < 0.01) and less likely to exhibit fibrosis (P < 0.01) and epithelial changes (P < 0.01). CONCLUSION CI is accompanied by a broad spectrum of pathological findings. The traditional pathognomonic findings of CI are rare and cannot be relied upon to exclude the diagnosis. Patients with IRCI and/or poor outcomes were more likely to have pathological findings of necrosis than patients who had ILCI and/or nonpoor outcomes.
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Affiliation(s)
- M Fenster
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - P Feuerstadt
- Yale University School of Medicine, New Haven, Connecticut, USA
- Gastroenterology Center of Connecticut, Hamden, Connecticut, USA
| | - L J Brandt
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Division of Gastroenterology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - M S Mansoor
- Department of Internal Medicine, Yale-New Haven Hospital, New Haven, CT, USA
| | - T Huisman
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - O C Aroniadis
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Division of Gastroenterology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
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44
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Park SK. Clinical assessment and treatment algorithm for lower gastrointestinal bleeding. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2018. [DOI: 10.18528/gii180024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Soo-Kyung Park
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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45
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Maeda H, Okamoto K, Namikawa T, Shiga M, Fujisawa K, Tadokoro M, Hanazaki K, Kobayashi M. Successful Laparoscopy-Assisted Resection of the Descending Colon in a Patient with Multiple Large Renal Cysts and Stricture of the Colon due to Ischemic Colitis. Case Rep Gastroenterol 2018; 12:540-545. [PMID: 30283290 PMCID: PMC6167646 DOI: 10.1159/000486953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/17/2018] [Indexed: 02/05/2023] Open
Abstract
Large pathological structures in the abdominal cavity curb the application of laparoscopic surgery. This case report describes a successful laparoscopy-assisted colectomy for benign colon disease in a patient with multiple large renal cysts. An 82-year-old man was referred to our department for treatment of stenosis of descending colon secondary to ischemic colitis. An abdominal computed tomography revealed multiple large renal cysts occupying a large proportion of the peritoneal cavity. To minimize the postoperative recovery period, laparoscopic surgery was planned despite the renal cysts. After inserting access ports, the walls of the several renal cysts were fenestrated with an electronic scalpel and the serous fluid was aspirated to enable continuation of the laparoscopic colectomy. The left colon was mobilized and extracted through an incision at the umbilicus, and the affected part of the colon was resected safely. The patient's postoperative course was uneventful, and the present case suggests that laparoscopy-assisted colectomy can be performed safely even in patients with multiple large renal cysts.
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Affiliation(s)
- Hiromichi Maeda
- Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, Japan
| | - Ken Okamoto
- Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, Japan
| | - Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Mai Shiga
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Kazune Fujisawa
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Michiko Tadokoro
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Michiya Kobayashi
- Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, Japan
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46
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Hsu CC, Chen PY, Lai CC. Thigh emphysema as the initial presentation of colon ischemia. Am J Emerg Med 2018; 36:526.e1-526.e3. [PMID: 29290506 DOI: 10.1016/j.ajem.2017.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/04/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022] Open
Abstract
The incidence of colon ischemia has increased in recent years, and is associated with high morbidity and mortality. The typical presentations of colon ischemia include abdominal pain, bloody diarrhea, and in severe case, ileus, fever and peritonitis. Here, we document a rare case of colon ischemia presenting with subcutaneous and intramuscular emphysema of the thigh. A 76-year-old woman presented to the emergency department for left thigh pain for three days. Physical examination revealed tenderness without obvious crepitus, erythema or swelling over the left groin area and a soft abdomen without tenderness. Plain abdominal film showed abnormal gas formation at the left thigh and chest film demonstrated subphrenic free air. Abdominal computer tomography found sigmoid perforation causing left retroperitoneal abscess, and subcutaneous and intramuscular emphysema over the left pelvic and thigh region. During operation, irreversible ischemia from the terminal ileum through the cecum to the sigmoid colon with gangrene and retroperitoneal abscess were found. Total colectomy with end ileostomy and peritoneal toilet were performed. However, massive bloody ascites from abdominal drainage developed on the 13th day of admission. She later passed away due to hemorrhagic shock. In conclusion, emphysema of the thigh may rarely be caused by an intestinal lesion, such as colon ischemia. Clinicians should be alert of these unusual presentations to find the hidden underlying etiologies.
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Affiliation(s)
- Chin-Chuan Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
| | - Ping-Yuan Chen
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi-Mei Medical Center, Liouying, Taiwan.
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47
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Assarzadegan N, Montgomery E, Pezhouh MK. Colitides: diagnostic challenges and a pattern based approach to differential diagnosis. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.mpdhp.2017.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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48
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Nikolic AL, Keck JO. Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management. ANZ J Surg 2017; 88:278-283. [PMID: 29124893 DOI: 10.1111/ans.14237] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 07/26/2017] [Indexed: 12/16/2022]
Abstract
Ischaemic colitis is the most common form of gastrointestinal ischaemia, but may be confused with acute mesenteric ischaemia, inflammatory bowel disease or infectious colitis. This review article outlines the current classification, epidemiology and risk factors, as well as approaches about diagnosis and management to guide clinical practice. It also identifies areas for further research.
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Affiliation(s)
- Amanda L Nikolic
- Department of Colon and Rectal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - James O Keck
- Department of Colon and Rectal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
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Yngvadottir Y, Karlsdottir BR, Hreinsson JP, Ragnarsson G, Mitev RUM, Jonasson JG, Möller PH, Björnsson ES. The incidence and outcome of ischemic colitis in a population-based setting. Scand J Gastroenterol 2017; 52:704-710. [PMID: 28276832 DOI: 10.1080/00365521.2017.1291718] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Population-based studies on patients with ischemic colitis (IC) are limited. We aimed to determine the incidence, risk factors and outcome of patients with IC. METHODS A retrospective nationwide study was conducted on adult patients with histologically confirmed IC in 2009-2013 in Iceland. IC patients were matched for age and gender with patients hospitalized with lower gastrointestinal bleeding. Data were collected on clinical presentation, comorbidities, smoking habits, management and outcome. RESULTS Eighty-nine patients, 61 (69%) females and mean age of 65 years (±17), fulfilled the predetermined criteria. Females were older than males, 68 years (±14) vs. 59 years (±20) (p = .0170). The mean cumulative incidence was 7.3 cases per 100,000 inhabitants. A total of 57 (64%) patients presented with abdominal pain, hematochezia and diarrhea. IC was localized in the left colon in 78 (88%) patients. Overall, 62 (70%) patients had cardiovascular disease vs. 53 (60%) of control group (NS) and 55 (62%) had a history of smoking vs. 53 (60%) in control group (NS). Ten (11%) patients required surgery and/or died within 30-days from hospital admission. At the end of follow-up, 7 (9%) patients had experienced recurrence of IC with an estimated 3-year recurrence rate of 15%. CONCLUSIONS IC is a common clinical phenomenon that affects a wide range of age groups, but is most prominent among elderly women. It typically presents with a clinical triad of abdominal pain, hematochezia and diarrhea. Most cases are mild and self-limiting with a good prognosis.
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Affiliation(s)
- Y Yngvadottir
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , The National University Hospital of Iceland , Reykjavik , Iceland
| | - B R Karlsdottir
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , The National University Hospital of Iceland , Reykjavik , Iceland
| | - J P Hreinsson
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , The National University Hospital of Iceland , Reykjavik , Iceland
| | - G Ragnarsson
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , The National University Hospital of Iceland , Reykjavik , Iceland
| | - R U M Mitev
- b Department of Pathology , The National University Hospital of Iceland , Reykjavik , Iceland
| | - J G Jonasson
- b Department of Pathology , The National University Hospital of Iceland , Reykjavik , Iceland
| | - P H Möller
- c Department of Surgery , The National University Hospital of Iceland , Reykjavik , Iceland
| | - E S Björnsson
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , The National University Hospital of Iceland , Reykjavik , Iceland
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50
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Pastor-Juan MDR, Ripollés T, Martí-Bonmatí L, Martínez MJ, Simó L, Gómez D, Revert R. Predictors of severity in ischemic colitis: Usefulness of early ultrasonography. Eur J Radiol 2017; 96:21-26. [PMID: 29103470 DOI: 10.1016/j.ejrad.2017.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 09/04/2017] [Accepted: 09/08/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE The main objective was to evaluate the usefulness of early ultrasonography for determining prognosis of patients with ischemic colitis. MATERIALS AND METHODS We reviewed the histories of patients with diagnosis of ischemic colitis over a period of 11 years. Two hundred twenty nine patients with ischemic colitis were included. Demographic, clinical, laboratory and sonographic findings were retrospectively analyzed. Patients were divided into two groups according to the outcome: mild (those who improved with conservative treatment) or severe (those who died or required surgery), and the findings of each group were compared. In addition, we developed a predictive model of multivariate logistic regression analysis, and then it was validated in a different population of 58 consecutive patients with ischemic colitis. RESULTS The mild ischemic colitis group consisted of 184 patients (age 74,7±8,8years), and the severe group of 45 patients (age 78,6±7,7years). More pancolitis (p=0.005), altered pericolic fat (p=0.032) and free fluid (p=0.013) was observed in the severe ischemic colitis group compared with the mild group. Severe ischemic group had lower wall thickness (p=0.020) and higher resistive index than mild group (p=0.025). Multivariate analysis identified as protective factors to severe ischemic colitis: pain (p=0.026), diarrhea (p=0.034), rectal bleeding (p=0.000), and hypertension (p=0.001). Altered pericolic fat (p=0.008) and pancolitis (p=0.017) were sonographic findings significantly related to severe ischemic colitis. Our model correctly classified 88.4% of the study patients and 89.6% of the population of 58 patients used in validation. CONCLUSIONS Sonographic features with clinical findings can predict the outcome of ischemic colitis. Our predictive model could differentiate properly between patients with mild or severe ischemic colitis.
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Affiliation(s)
- María Del Rosario Pastor-Juan
- Department of Radiology, Complejo Hospitalario Universitario de Albacete, 37 Hermanos Falcó St., Albacete 02006, Spain.
| | - Tomás Ripollés
- Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Ave., Valencia 46017, Spain.
| | - Luis Martí-Bonmatí
- Deparment of Radiology, Hospital Universitari i Politecnic La Fe, 106 Fernando Abril Martorell Ave., Valencia 46026, Spain.
| | - María Jesús Martínez
- Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Ave., Valencia 46017, Spain.
| | - Luis Simó
- Deparment of Radiology, Hospital Universitari Arnau de Vilanova, 12, Sant Clement St., Valencia 46015, Spain.
| | - Diana Gómez
- Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Ave., Valencia 46017, Spain.
| | - Rafael Revert
- Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Ave., Valencia 46017, Spain.
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