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Iqbal H, Haddadin R, Zhang P, Haidary H, Prajapati D. Long-term aspirin use in patients hospitalized with ischemic colitis. Ann Gastroenterol 2024; 37:31-36. [PMID: 38223253 PMCID: PMC10785027 DOI: 10.20524/aog.2024.0848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/30/2023] [Indexed: 01/16/2024] Open
Abstract
Background Ischemic colitis is a form of mesenteric ischemia that often presents in patients with vascular disease. Long-term aspirin use has been shown to improve the outcomes in patients with cardiovascular or cerebrovascular disease. However, the relationship between aspirin use and ischemic colitis is unclear. Methods Patients with a diagnosis of ischemic colitis were identified using the 2020 Nationwide Inpatient Sample. Patients were stratified by long-term aspirin use at the time of hospitalization. Data were collected regarding mortality, bowel perforation, peritonitis, shock, blood transfusion, length of stay in days (LOS), hospital charges, age, sex, race, primary insurance, median income, hospital region, hospital size, and comorbidities. The relationship between aspirin use and outcomes was analyzed using multivariate regression analysis. Results A total of 67,685 patients were included. Aspirin users had a mean age of 72.8 years compared to 66.8 years for non-aspirin users. Long-term aspirin use was associated with a lower risk of in-hospital mortality (P<0.001), bowel perforation (P<0.001), peritonitis (P=0.01), shock (P<0.001), and blood transfusion (P<0.001). The mean LOS was 6.1 days in the aspirin group compared to 9.4 days in the non-aspirin group. Ischemic colitis patients taking aspirin had a mean hospitalization charge of $87,123 compared to $161,610 for those not using aspirin. Conclusions Our study examined the impact of aspirin use in ischemic colitis patients. Among patients hospitalized with ischemic colitis, we found that long-term aspirin use was associated with a lower risk of in-hospital mortality and adverse events.
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Affiliation(s)
- Humzah Iqbal
- Department of Internal Medicine, University of California San Francisco, Fresno, CA (Humzah Iqbal)
| | - Rakahn Haddadin
- Department of Internal Medicine, Sunrise Health Graduate Medical Education Consortium, MountainView Hospital, Las Vegas, NV (Rakahn Haddadin)
| | - Patrick Zhang
- California Health Sciences University College of Osteopathic Medicine, Clovis, CA (Patrick Zhang)
| | - Hasib Haidary
- American University of Antigua College of Medicine, Osbourn, Antigua and Barbuda (Hasib Haidary)
| | - Devang Prajapati
- Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, CA (Devang Prajapati), USA
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2
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Suh JW, Floud S, Reeves GK, Cairns BJ, Wright FL. Multimorbidity of cardiovascular disease subtypes in a prospective cohort of 1.2 million UK women. Open Heart 2023; 10:e002552. [PMID: 38097361 PMCID: PMC10729279 DOI: 10.1136/openhrt-2023-002552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE Cardiovascular multimorbidity (CVM) is the co-occurrence of multiple cardiovascular disease subtypes (CVDs) in one person. Because common patterns and incidence of CVM are not well-described, particularly in women, we conducted a descriptive study of CVM in the Million Women Study, a large population-based cohort of women. METHODS UK women aged 50-64 years were followed up using hospital admissions and mortality records for an average of 19 years. CVM was defined as having ≥2 of 19 selected CVDs. The age-specific cumulative incidence of CVM between age 60 and 80 years was estimated. The numbers and proportions of individual, pairs and other combinations of CVDs that comprised incident CVM were calculated. For each individual CVD subtype, age-standardised proportions of the counts of other co-occurring CVDs were estimated. RESULTS The age-specific likelihood of having CVM nearly doubled every 5 years between age 60 and 80 years. Among 1.2 million women without CVD at study baseline, 16% (n=196 651) had incident CVM by the end of follow-up. Around half of all women with CVM had a diagnosis of ischaemic heart disease (n=102 536) or atrial fibrillation (n=96 022), almost a third had heart failure (n=72 186) and a fifth had stroke (n=40 442). The pair of CVDs with the highest age-adjusted incidence was ischaemic heart disease and atrial fibrillation (18.95 per 10 000 person-years). Over 60% of individuals with any given CVD subtype also had other CVDs, after age standardisation. CONCLUSIONS CVM is common. The majority of women with any specific CVD subtype eventually develop at least one other. Clinical and public health guidelines for CVD management should acknowledge this high likelihood of CVM.
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Affiliation(s)
- Jae Won Suh
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Sarah Floud
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gillian K Reeves
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Benjamin J Cairns
- Our Future Health, London, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Frances Lucy Wright
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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3
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Chong Tai LI, Ahmed S, Chokshi RR. Ischemic Colitis in a Young Female Following Herbal Supplement Ingestion. Cureus 2023; 15:e45315. [PMID: 37846238 PMCID: PMC10577007 DOI: 10.7759/cureus.45315] [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] [Accepted: 09/15/2023] [Indexed: 10/18/2023] Open
Abstract
Ischemic colitis is typically considered a disease of the elderly, given their atherosclerotic risk factors and other comorbidities. Ischemic colitis in the younger population is considered very uncommon. We present an interesting case of a young female presenting with abdominal pain and hematochezia found to have ischemic colitis on pathological biopsy results after a colonoscopy. She was an otherwise healthy female with no medical problems prior to her hospitalization but endorsed recent use of a bitter herbal tea to relieve her symptoms. Here, we review potential causes of ischemic colitis, including herbal remedies, which have been linked to causing hypercoagulable and hypotensive states.
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Affiliation(s)
| | - Syed Ahmed
- Internal Medicine, Broward Health Medical Center, Fort Lauderdale, USA
| | - Rajiv R Chokshi
- Internal Medicine, Broward General Medical Center, Fort Lauderdale, USA
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Khanal S, Bhatt T, Schmidt P, Hallal PL, Zaw M. Ischemic Colitis or Colon Cancer: A Diagnostic Dilemma. Cureus 2023; 15:e36206. [PMID: 37069878 PMCID: PMC10105066 DOI: 10.7759/cureus.36206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
Ischemic colitis, a potentially reversible pathology of the colon, can masquerade in its presentation as colonic carcinoma. It typically presents with cramping abdominal pain, diarrhea, and per-rectal bleeding. Colonoscopy remains the diagnostic modality of choice that typically shows friable, edematous, or erythematous mucosa with scattered hemorrhagic erosions or ulcerations. Although rare, the colonoscopic findings can sometimes reveal a tumor mass that confounds the diagnosis of ischemic colitis as colonic carcinoma. Our patient was a 78-year-old female with no previous colon cancer screening who presented with a mass-forming variant of ischemic colitis. Due to the overlap in presentations, radiographic findings, and colonoscopic findings, the diagnostic challenge was evident. Ultimately, colon cancer was ruled out through thorough colonoscopic follow-up and biopsy-guided pathological analysis. This case signifies the importance of considering colonic mass as a guise of underlying ischemic colitis to ensure an accurate diagnosis and the best possible outcome for the patient.
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Chen YC, Tsai YY, Chang SC, Chen HC, Ke TW, Fingerhut A, Chen WTL. Laparoscopic versus open emergent colectomy for ischemic colitis: a propensity score-matched comparison. World J Emerg Surg 2022; 17:53. [PMID: 36229844 PMCID: PMC9563494 DOI: 10.1186/s13017-022-00458-4] [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: 06/09/2022] [Accepted: 10/06/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Laparoscopic colectomy is rarely performed for ischemic colitis. The aim of this propensity score-matched study was to compare preoperative characteristics, intraoperative details and short-term outcomes for emergent laparoscopic colectomy versus the traditional open approach for patients with ischemic colitis.
Methods Retrospective review of 96 patients who underwent emergent colectomy for ischemic colitis between January 2011 and December 2020 (39 via laparoscopy, 57 via laparotomy) was performed. We compared short-term outcomes after using a one-to-one ratio and nearest-neighbor propensity score matching to obtain similar preoperative and intraoperative parameters in each group. Results Patients in the open group experienced more surgical site complications (52.6% vs. 23.0%, p = 0.004), more intra-abdominal abscesses (47.3% vs. 17.9%, p = 0.003), longer need for ventilator support (20 days vs. 0 days, p < 0.001), more major complications (77.2% vs. 43.5%, p = 0.001), higher mortality (49.1% vs. 20.5%, p = 0.004), and longer hospital stay (32 days vs. 19 days, p = 0.001). After propensity score matching (31 patients in each group), patients undergoing open (vs. laparoscopy) had more surgical site complications (45.1% vs. 19.4%, p = 0.030) and required longer ventilator support (14 vs. 3 days, p = 0.039). After multivariate analysis, Charlson Comorbidity Index (p = 0.024), APACHE II score (p = 0.001), and Favier’s classification (p = 0.023) were independent predictors of mortality. Conclusions Laparoscopic emergent colectomy for ischemic colitis is feasible and is associated with fewer surgical site complications and better respiratory function, compared to the open approach.
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Affiliation(s)
- Yi-Chang Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.,Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Yuan-Yao Tsai
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Sheng-Chi Chang
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Hung-Chang Chen
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Tao-Wei Ke
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Abe Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - William Tzu-Liang Chen
- Department of Colorectal Surgery, China Medical University Hsinchu Hospital, No. 199, Sec.1, Xinglong RD, Zhubei City, 30272, Hsinchu County, Taiwan, ROC.
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Praxenthaler J, Kirchner C, Schwier E, Altmann S, Wittmer A, Henzler D, Köhler T. Case report: Early detection of mesenteric ischemia by intravital microscopy in a patient with septic shock. Front Med (Lausanne) 2022; 9:985977. [PMID: 36091703 PMCID: PMC9458872 DOI: 10.3389/fmed.2022.985977] [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] [Received: 07/04/2022] [Accepted: 08/04/2022] [Indexed: 11/17/2022] Open
Abstract
Gut ischemia is a frequent but underdiagnosed complication, especially in critically ill intensive care patients, and represents a special diagnostic challenge that can only be solved in an interdisciplinary manner. We report a case of a 54-year-old woman with acute mesenteric ischemia (AMI) as a cause of septic shock diagnosed by intravital microscopy (IVM) 2 days before visible necrotic changes in a multimodality approach. We show that intravital microscopy can be a serious alternative for the early diagnosis of mesenteric ischemia in the hands of the skilled. We use this case to discuss the value and clinical perspective of IVM in the intensive care setting.
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Affiliation(s)
- Janina Praxenthaler
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Klinikum Herford, Ruhr University Bochum, Herford, Germany
- Department of Anesthesiology, Intensive Care and Pain Medicine, Kliniken Südostbayern, Klinikum Traunstein, Traunstein, Germany
| | - Carmen Kirchner
- Department of General and Visceral Surgery, Thoracic Surgery and Proctology, Klinikum Herford, Ruhr University Bochum, Herford, Germany
| | - Elke Schwier
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Klinikum Herford, Ruhr University Bochum, Herford, Germany
| | - Simon Altmann
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Klinikum Herford, Ruhr University Bochum, Herford, Germany
- Department of Anesthesiology, Intensive Care and Pain Medicine, Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Axel Wittmer
- Institute of Pathology, Klinikum Herford, Herford, Germany
| | - Dietrich Henzler
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Klinikum Herford, Ruhr University Bochum, Herford, Germany
| | - Thomas Köhler
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Klinikum Herford, Ruhr University Bochum, Herford, Germany
- Department of Anesthesiology and Intensive Care Medicine, AMEOS-Klinikum Halberstadt, Halberstadt, Germany
- *Correspondence: Thomas Köhler,
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Gupta S, Allegretti JR. Mimics of Crohn's Disease. Gastroenterol Clin North Am 2022; 51:241-269. [PMID: 35595413 DOI: 10.1016/j.gtc.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Crohn's disease is a chronic inflammatory disease that can affect any portion of the gastrointestinal tract. Associated symptoms can vary based on the severity of disease, extent of involvement, presence of extraintestinal manifestations, and development of complications. Diagnosis is based on a constellation of findings. Many diseases can mimic Crohn's disease and lead to diagnostic conundrums. These include entities associated with the gastrointestinal luminal tract, vascular disease, autoimmune processes, various infections, malignancies and complications, drug- or treatment-induced conditions, and genetic diseases. Careful consideration of possible causes is necessary to establish the correct diagnosis.
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Affiliation(s)
- Sanchit Gupta
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, 850 Boyslton Street, Suite 201, Chestnut Hill, MA 02467, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Jessica R Allegretti
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, 850 Boyslton Street, Suite 201, Chestnut Hill, MA 02467, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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8
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Umar Z, Ilyas U, Shah D, Nso N, Foster A, Zirkiyeva M. Lactulose-Induced Ischemic Colitis: A Rare Presentation and an Overview of Possible Etiologies of the Disease. Cureus 2022; 14:e23774. [PMID: 35509729 PMCID: PMC9062685 DOI: 10.7759/cureus.23774] [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] [Accepted: 04/03/2022] [Indexed: 12/04/2022] Open
Abstract
Ischemic colitis is one of the most common ischemic pathologies of the gastrointestinal system and can be divided into non-gangrenous and gangrenous forms. The pathophysiology involves restricted blood supply to the colonic mucosa. Several risk factors have been implicated in the development of ischemic colitis. Lactulose, one of the mainstay therapies for the treatment of hepatic encephalopathy in patients with cirrhosis, has been rarely reported as a cause of ischemic colitis. To the best of our knowledge, there has been only one case report associating lactulose use with the development of ischemic colitis. The exact pathophysiology is unknown but might be associated with the fermentation of lactulose by intestinal bacteria, causing gaseous distention and increasing the intraluminal pressure. We present the case of a 77-year-old African American male, a known case of non-alcoholic liver cirrhosis with portal hypertension and esophageal varices, brought in by his family to the emergency department for altered mental status, non-bilious vomiting, abdominal distension, and pain for one day. On physical examination, the patient had upper extremity asterixis and was alert but disoriented to place and person. Diagnostic paracentesis was performed, which revealed leukocytosis, predominantly neutrophils. The patient was admitted for spontaneous bacterial peritonitis and hepatic encephalopathy with decompensated liver cirrhosis. The patient was started lactulose with a goal of three to four bowel movements per day. Despite adequate treatment, the patient continued to develop worsening mental function and abdominal distension. This was later followed by a bloody bowel movement. Laboratory assessment showed an elevated white blood cell count, worsening kidney function, and high anion gap metabolic acidosis. CT scan revealed dilated loops of bowel with air and fluid along with submucosal wall edema, findings suggestive of ischemic colitis. Given the poor prognosis and the patient's condition, colonoscopy was deferred. Lactulose was discontinued, as it was thought to be a contributing cause of the patient's ischemic colitis. His condition continued to deteriorate, and he passed away on Day 18 of admission.
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9
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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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10
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Outcomes of patients with ischemic colitis causing severe hematochezia managed medically or surgically. Langenbecks Arch Surg 2022; 407:1625-1636. [DOI: 10.1007/s00423-022-02441-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
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11
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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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Nana P, Spanos K, Dakis K, Karathanos C, Kouvelos G, Giannoukas A. Factors Associated With Noninfectious Fever After Endovascular Aortic Aneurysm Repair. J Endovasc Ther 2021; 29:739-745. [PMID: 34964389 DOI: 10.1177/15266028211065966] [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] [Indexed: 12/07/2022]
Abstract
PURPOSE The post-endovascular abdominal aortic aneurysm repair (EVAR) inflammatory response, which is very often associated with fever, has been ascribed to a wide range of proinflammatory mediators and operative events. The aim of this study was to evaluate the impact of such factors in the development of fever of noninfectious origin after elective EVAR. MATERIALS AND METHODS A retrospective analysis of prospectively collected data of patients treated with standard elective EVAR between February 2017 and December 2020 was undertaken. The database included patients' demographics and comorbidities, as well as laboratory inflammatory markers (white blood cell count, neutrophils, and C-reactive protein [CRP]) and anatomical characteristics (sac diameter, inferior mesenteric artery [IMA] patency and diameter, number of patent lumbar arteries, internal iliac artery [IIA] patency or occlusion). Intraoperative details, such as type of stent graft material and IIA overstenting, were also analyzed. Patients with infectious postoperative complications or previously receiving systemic anti-inflammatory medication were excluded. Statistical analysis was performed by SPSS 22.0 for Windows software (IBM Corp, Armonk, New York). RESULTS From 332 patients treated with elective EVAR between 2017 and 2020, 268 patients (all men) were included in the analysis. The mean age was 72.1±7.5 years and the mean aneurysm diameter was 59.1±12.1 mm. Seventeen patients were excluded due to a known infection site. From the study cohort, 114 (42.5%) patients presented with fever. Multivariate regression analysis confirmed that the occlusion of IMA ≥5 mm (p<0.008) and higher CRP (p<0.001) were independent factors associated with postoperative fever. A subanalysis was performed only on patients with patent IMA before EVAR. In the multivariate regression analysis of this subgroup, IMA ≥5 mm (p=0.008), presence of dyslipidemia (p=0.037), and higher CRP (p<0.001) were related to fever. CONCLUSION Occlusion of an existing wide (≥5 mm) and patent IMA prior to EVAR may contribute to the development of post-EVAR pyrexia. The CRP is a reliable marker for post-EVAR fever. Further prospective studies are needed to corroborate these findings.
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Affiliation(s)
- Petroula Nana
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Konstantinos Spanos
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Konstantinos Dakis
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Christos Karathanos
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - George Kouvelos
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Athanasios Giannoukas
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
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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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14
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Watanabe S, Shiraishi O, Nanke I, Uchidate K, Machida T, Igarashi A, Kobashi K, Soejima M, Negi M, Yauchi T. A rare case of ulcerative colitis in a patient who developed acute ischemic colitis associated with Takayasu arteritis. Clin J Gastroenterol 2021; 14:1671-1678. [PMID: 34378179 DOI: 10.1007/s12328-021-01500-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/08/2021] [Indexed: 12/04/2022]
Abstract
Intestinal ischemia is a rare complication of Takayasu arteritis (TAK), which often requires colectomy. We report the case of a 27 year-old man with ulcerative colitis (UC), who was admitted to our hospital due to abdominal pain. Computed tomography revealed an edematous wall of the ascending colon with ascites and a thickened aortic wall with mild stenosis of the superior mesenteric artery (SMA), suggesting large vessel vasculitis, especially TAK. Colonoscopy revealed acute ischemic colitis associated with mild stenosis of the SMA caused by TAK, but there was no worsening of UC. The patient was successfully treated with conservative therapy.
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Affiliation(s)
- Sho Watanabe
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1, Soka, Soka-shi, Saitama, 340-8560, Japan.
| | - Orie Shiraishi
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1, Soka, Soka-shi, Saitama, 340-8560, Japan
| | - Ittoku Nanke
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1, Soka, Soka-shi, Saitama, 340-8560, Japan
| | - Kozue Uchidate
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1, Soka, Soka-shi, Saitama, 340-8560, Japan
| | - Tomoyo Machida
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1, Soka, Soka-shi, Saitama, 340-8560, Japan
| | - Akira Igarashi
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1, Soka, Soka-shi, Saitama, 340-8560, Japan
| | - Kenichiro Kobashi
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1, Soka, Soka-shi, Saitama, 340-8560, Japan
| | - Makoto Soejima
- Department of Rheumatology, Soka Municipal Hospital, Saitama, Japan
| | - Mariko Negi
- Department of Pathology, Soka Municipal Hospital, Saitama, Japan
| | - Tsunehito Yauchi
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1, Soka, Soka-shi, Saitama, 340-8560, Japan
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15
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Melo N, Hipólito I, Alves Pereira J, Cunha P, Almeida J. Colon Ischaemia Induced by Amoxicillin-related Anaphylactic Shock. Eur J Case Rep Intern Med 2021; 8:002640. [PMID: 34268268 PMCID: PMC8276922 DOI: 10.12890/2021_002640] [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] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022] Open
Abstract
Colon ischaemia is the most frequent type of ischaemia of the digestive tract. It is more common among the elderly, especially patients with haemodynamic disturbance. In young patients, it is associated with particular drugs such as oral contraceptives and ergotamine derivatives. Anaphylaxis is characterized by acute onset and skin and mucosal involvement together with cardiovascular involvement. Gastrointestinal symptoms are common in anaphylaxis, but gastrointestinal bleeding and acute colon ischaemia are rarely described. Here, we present the case of a 52-year-old woman with acute ischaemic colitis associated with an anaphylactic reaction to amoxicillin.
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Affiliation(s)
- Nuno Melo
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Isabel Hipólito
- Intensive Care Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Joana Alves Pereira
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Pedro Cunha
- Intensive Care Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Jorge Almeida
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
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16
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Xiao W, Zhou SY, Wu K, Deng B, Wu D, Wang Y, Gong W, Ding Y, Lu G. Low-dose aspirin and the severity of ıschemic colitis: A single-center retrospective study. TURKISH JOURNAL OF GASTROENTEROLOGY 2021; 31:848-852. [PMID: 33625996 DOI: 10.5152/tjg.2020.19507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND/AIMS This retrospective study aimed to evaluate the effect of low-dose aspirin (50-150 mg/d) on the severity of ischemic colitis. MATERIALS AND METHODS A total of 244 patients admitted to our hospital for ischemic colitis between 2013 and 2018 were included in the study. Patients were divided into two groups-aspirin and non-aspirin groups-based on their recent history of aspirin use before the onset of ischemic colitis. Clinical performance, biochemical indices, and endoscopic findings were compared. RESULTS The average age and the proportion of underlying disease, including hypertension, cerebral infarction, and coronary heart disease in the aspirin group was significantly higher than those in the non-aspirin group (p<0.05). In terms of clinical symptoms, the proportion of diarrhea in the aspirin group was significantly higher than that in the non-aspirin group, while the proportion of abdominal pain was significantly lower in the aspirin group compared with the non-aspirin group. Colonoscopy results showed that the incidence of ulceration was significantly higher in the aspirin group than in the non-aspirin group (p<0.05). CONCLUSION The use of low-dose aspirin may aggravate the severity and mask the symptoms of abdominal pain in ischemic colitis.
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Affiliation(s)
- Weiming Xiao
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China;Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Shuai Yang Zhou
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China;Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Keyan Wu
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China;Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Bin Deng
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China;Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Dacheng Wu
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China;Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yuanzhi Wang
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China;Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Weijuan Gong
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China;Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yanbing Ding
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China;Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
| | - Guotao Lu
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China;Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China
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17
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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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18
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Sakaguchi H, Shirakawa T, Mizuochi T. Ischemic colitis in an infant with constipation treated with stimulant laxative. JGH OPEN 2020; 4:1012-1013. [PMID: 33102779 PMCID: PMC7578304 DOI: 10.1002/jgh3.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/07/2020] [Indexed: 11/15/2022]
Abstract
Ischemic colitis (IC), the most common form of intestinal ischemia, ranges from superficial mucosal and submucosal injury to full‐thickness mural necrosis. As risk factors include cerebrovascular disease, hypertension, diabetes mellitus, prior abdominal surgery, irritable bowel syndrome, and constipation, IC typically occurs in elderly persons with multiple comorbidities rather than young children. A 1‐year‐old Japanese girl receiving a stimulant laxative for constipation since age 7 months was hospitalized for fever, vomiting, and hypovolemic shock. Her abdomen was swollen, and abdominal computed tomography showed colonic distension with abundant stool. Colonic decompression and intensive care brought about rapid improvement until persistent bloody diarrhea that commenced on day 17 of illness required transfer to another hospital, where colonoscopy on day 42 showed mucosal sloughing forming pseudomembranes, as well as focal stenosis. Contrast enema on day 45 confirmed stenosis with a “thumbprint” contour at the splenic flexure. Diagnosed with IC, she received parenteral nutrition and an elemental diet. Bloody diarrhea resolved by day 75. Colonoscopy and contrast enema on day 110 showed normal mucosa and resolution of stenosis. We believe that IC arose from constipation and stimulant laxative treatment and consider this to be the first report of infantile IC complicating constipation.
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Affiliation(s)
- Hirotaka Sakaguchi
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
| | | | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
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19
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Abstract
Vasovagal reactions are the most common type of adverse reaction after blood donation; however, there are no reports of ischemic colitis as an adverse reaction after blood donation. A previously healthy 55-year-old woman suffered loss of consciousness at the end of her first plasma donation. She was diagnosed with a vasovagal reaction and received hydration. However, she developed persistent left flank pain and watery diarrhea, followed by bloody diarrhea. Abdominal computed tomography confirmed ischemic colitis. She was asked to fast and was eventually discharged 7 days later. We should consider the possibility of ischemic colitis if patients develop persistent abdominal pain after transient hypotension, such as that observed during a vasovagal reaction.
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Affiliation(s)
- Naoto Mizumura
- Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Japan
| | - Takuma Kishimoto
- Department of General Medicine and Primary Care, Shiga University of Medical Science, Japan
| | - Tomoki Tanaka
- Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Japan
| | - Junji Shimizu
- Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Japan
| | - Takahisa Tabata
- Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Japan
| | - Yutaka Eguchi
- Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Japan
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20
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Kohlman-Trigoboff D, Rich K, Foley A, Fitzgerald K, Arizmendi D, Robinson C, Brown R, Treat-Jacobson D. Society for Vascular Nursing endovascular repair of abdominal aortic aneurysm updated nursing clinical practice guideline. JOURNAL OF VASCULAR NURSING 2020; 38:36-65. [PMID: 32534654 PMCID: PMC7707638 DOI: 10.1016/j.jvn.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/26/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Debra Kohlman-Trigoboff
- Duke University Medical Center, Division of Cardiology, Duke Heart and Vascular, Durham, North Carolina.
| | - Kathleen Rich
- Critical Care Administration, Franciscan Health-Michigan City, Michigan City, Indiana
| | - Anne Foley
- Department of Vascular Surgery, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen Fitzgerald
- The Vascular Group, PLLC, Albany Medical Center Hospital, Albany, New York
| | - Dianne Arizmendi
- Corporal Michael Crescenz VA Hospital, Philadelphia, Pennsylvania
| | | | - Rebecca Brown
- National Institutes of Health's National Center for Advancing Translational Sciences, University of Minnesota School of Nursing, Minneapolis, Minnesota
| | - Diane Treat-Jacobson
- Nursing Research for Improved Care, University of Minnesota School of Nursing, Minneapolis, Minnesota
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21
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Gupta AK, Vazquez OA, Burgos MI, Buicko J, Lopez-Viego M. Fulminant Ischemic Pancolitis: A Severe Variant of Ischemic Colitis. Cureus 2020; 12:e7720. [PMID: 32431998 PMCID: PMC7233966 DOI: 10.7759/cureus.7720] [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: 11/05/2022] Open
Abstract
We present the case of a 75-year-old female with abdominal pain and a sudden change in mental status. She progressed rapidly with manifestations of acidosis without episodes of bloody bowel movements or diarrhea. The patient underwent emergent exploratory laparotomy, and a diagnosis of fulminant ischemic pancolitis was made with visual confirmation of infarcted colon from cecum to proximal rectum leading to subtotal colectomy and ileostomy. Postoperatively, the patient showed improved acidosis and mental status; unfortunately, over the subsequent days, the patient declined and was transferred to hospice and palliative care.
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Affiliation(s)
- Anupam K Gupta
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Oscar A Vazquez
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Monica I Burgos
- Internal Medicine, Universidad Autonoma de Guadalajara, Guadalajara, MEX
| | - Jessica Buicko
- Endocrine Surgery, Bethesda Hospital East/Florida Atlantic University, Boynton Beach, USA
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22
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Ruffatti A, Calligaro A, Lacognata CS, D'Odorico A, Colpo A, Cardin F, Calabrese F. Insights into the pathogenesis of catastrophic antiphospholipid syndrome. A case report of relapsing catastrophic antiphospholipid syndrome and review of the literature on ischemic colitis. Clin Rheumatol 2019; 39:1347-1355. [PMID: 31853731 DOI: 10.1007/s10067-019-04888-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 11/28/2022]
Abstract
We present the case of a woman with a severe clinical history of antiphospholipid syndrome and persistent positivity for lupus anticoagulant, IgG anticardiolipin and IgG anti-β2Glycoprotein I antibodies. An acute clinical onset characterized by severe abdominal pain immediately followed by circulatory shock and histological colonic small vessel thrombosis pattern pointed to a diagnosis of ischemic colitis. The subsequent rapid onset of pulmonary alveolitis and heart failure associated to subendocardial hypoperfusion led to a diagnosis of definite catastrophic antiphospholipid syndrome (CAPS). Conventional triple therapy together with a broad-spectrum preventive antibiotic therapy were quickly initiated, and the outcome was favorable. We evaluated the patients with ischemic colitis in CAPS described in the literature between 1992 and May 2019 and our CAPS case. In accordance with the "two-hit" hypothesis and on the basis of the patients' data, we would like to speculate that the colonic wall necrosis related to ischemic colitis damaged the intestinal barrier causing loss of resistance to bacteria and leading to endotoxemia and bacteremia with bacteria translocation through the circulatory stream to the lungs and heart. The bacteria acted as the priming factor which favored the binding of β2Glycoprotein I to the endothelium vessels in the colon, lungs, and heart following activation of anti-β2Glycoprotein I antibodies which attached to the domain I of β2Glycoprotein I. This was followed by complement activation which triggered the thrombotic and cytokine storm. If further clinical studies confirm this hypothesis, the treatment of CAPS could be more targeted and effective.
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Affiliation(s)
- Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Via Giustiniani, 2, 35128, Padua, Italy.
| | - Antonia Calligaro
- Rheumatology Unit, Department of Medicine, University Hospital of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Carmelo S Lacognata
- Radiology Unit, Department of Diagnostic Imaging and Interventional Radiology, University Hospital of Padua, Padua, Italy
| | - Anna D'Odorico
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy
| | - Anna Colpo
- Apheresis Unit, Department of Transfusion Medicine, University Hospital of Padua, Padua, Italy
| | - Fabrizio Cardin
- Endoscopic Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
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23
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Amore Bonapasta S, Lazzaro S, Passafiume F, Santoni S, Grassi GB, Longo G. Laparoscopic management of acute, severe colon ischaemia: demanding emergency extended left hemicolectomy with completely intracorporeal anastomosis - a video vignette. Colorectal Dis 2019; 21:1454-1455. [PMID: 31390476 DOI: 10.1111/codi.14812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 02/08/2023]
Affiliation(s)
| | | | | | | | | | - G Longo
- Policlinico Casilino, Rome, Italy
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24
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Kanai N, Hashimoto T, Fukuda M, Shijyo T. Acute ischemic colitis with hematochezia related to baloxavir marboxil treatment for influenza A. J Infect Chemother 2019; 25:1040-1042. [PMID: 31176533 DOI: 10.1016/j.jiac.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/13/2019] [Accepted: 05/15/2019] [Indexed: 10/26/2022]
Abstract
Oseltamivir, an established oral anti-influenza medication, increases the risk of ischemic colitis. Baloxavir marboxil is a novel oral anti-influenza medication, and few studies have evaluated its potential side effects, including ischemic colitis. Moreover, as influenza A can also induce ischemic colitis, drug-induced colitis associated with anti-influenza medication is not clearly understood. In this report, we describe the case of a 62-year-old Japanese woman who developed acute ischemic colitis after taking baloxavir for influenza A. The day after taking baloxavir (day 2), the patient experienced abdominal pain, diarrhea, and nausea. On day 3, she had developed hematochezia and decided to visit our hospital. Upon presentation, inflammation of the descending and sigmoid colon was detected by abdominal echography and computed tomography. Fluid replacement therapy and dietary restrictions were initiated. On day 4, the inflammation of the descending colon and marked intestinal edema were confirmed by colonoscopy. She was clinically diagnosed with ischemic colitis, from which she recovered completely by day 9. This case suggests that patients taking baloxavir may be at risk of developing ischemic colitis with hematochezia and underscores the need to further study the induction of this condition by commonly used oral anti-influenza agents.
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Affiliation(s)
- Norihito Kanai
- Niiza Hospital, Department of Pharmacy, 3-14-30, Horinouchi, Niiza, Saitama, 352-0023, Japan.
| | - Takafumi Hashimoto
- Niiza Hospital, Department of Pharmacy, 3-14-30, Horinouchi, Niiza, Saitama, 352-0023, Japan.
| | - Masataka Fukuda
- Niiza Hospital, Department of Internal Medicine, 3-14-30, Horinouchi, Niiza, Saitama, 352-0023, Japan.
| | - Takayuki Shijyo
- Niiza Hospital, Department of Gastroenterological Surgery, 3-14-30, Horinouchi, Niiza, Saitama, 352-0023, Japan.
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25
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Giannetti A, Matergi M, Biscontri M, Tedone F, Falconi L, Giovannelli L, Ussia V, Franci L, Pieraccini M. Multiparametric ultrasound in the diagnosis and monitoring of ischemic colitis: description of a case of ischemic colitis of the right colon and revision of the literature. J Ultrasound 2019; 22:477-484. [PMID: 31119715 DOI: 10.1007/s40477-019-00386-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022] Open
Abstract
The aim of this paper is to describe the usefulness of multiparametric US in the diagnosis and subsequent follow-up of a case of right-side ischemic colitis and to present a review of the data reported in the literature. Ischemic colitis is frequently diagnosed in the field of gastroenterology. Diagnosis is usually based on the outcome of endoscopy and histological examination, and in case of right-side ischemic colitis also on the results of contrast-enhanced CT. In the described case, multiparametric US indicated the diagnosis including a prognostic judgment, and during follow-up US-monitored patency of the stents positioned under angiographic guidance. One of the available US techniques, CEUS, seems to have a special role in the detection of residual vascularization of the gastrointestinal tract affected by ischemia. However, before introducing this method into daily clinical practice, further studies are required to confirm its diagnostic accuracy.
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Affiliation(s)
- Andrea Giannetti
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100, Grosseto, Italy.
| | - Marco Matergi
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100, Grosseto, Italy
| | - Marco Biscontri
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100, Grosseto, Italy
| | - Francesco Tedone
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100, Grosseto, Italy
| | - Lucia Falconi
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100, Grosseto, Italy
| | - Luca Giovannelli
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100, Grosseto, Italy
| | - Valeria Ussia
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100, Grosseto, Italy
| | - Luca Franci
- Radiology Department, Misericordia Hospital, Grosseto, Italy
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26
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Hayashi K, Ohshio Y, Hanaoka J. Gangrenous ischaemic colitis following lung wedge resection. BMJ Case Rep 2019; 12:12/5/e227908. [PMID: 31088812 DOI: 10.1136/bcr-2018-227908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A 77-year-old man, who was taking prednisolone 7.5 mg, underwent wedge resection for nodules in the right lower lobe of the lung. The nodules were diagnosed as amyloid tumour. On the sixth postoperative day, sudden tachycardia, fever, creatine phosphokinase increase, renal dysfunction and metabolic acidosis were observed. CT showed no signs of infection, exacerbation of interstitial pneumonia, pulmonary embolism or occlusion in the major vessels of the mesentery. Exploratory laparotomy revealed intestinal necrosis in the inferior mesenteric artery area, and left hemicolectomy was performed. Postoperative pathological examination revealed gangrenous ischaemic colitis. Although gangrenous ischaemic colitis is not a complication specific to general thoracic surgery, it can be fatal. Because of the high risk of developing gangrenous ischaemic colitis in elderly patients and the increase in concomitant diseases, thoracic surgeons should always be mindful of the condition.
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Affiliation(s)
| | | | - Jun Hanaoka
- Shiga University of Medical Science, Otsu, Japan
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27
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Robles-Martín ML, Reyes-Ortega JP, Rodríguez-Morata A. A Rare Case of Ischemia–Reperfusion Injury After Mesenteric Revascularization. Vasc Endovascular Surg 2019; 53:424-428. [DOI: 10.1177/1538574419839547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- María L. Robles-Martín
- Department of Angiology and Vascular Surgery, Quirónsalud Málaga Hospital, Málaga, Spain
| | - Juan P. Reyes-Ortega
- Department of Angiology and Vascular Surgery, Quirónsalud Málaga Hospital, Málaga, Spain
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