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Lopez-Saez B, Casalots A, Ballesteros E, Brunet-Mas E. Ischemic colitis due to Kayexalate crystals. Gastroenterol Hepatol 2024; 47:391-392. [PMID: 38007155 DOI: 10.1016/j.gastrohep.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/08/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Affiliation(s)
- Berta Lopez-Saez
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Alex Casalots
- Departament de Patologia, Consorci del Laboratoi Intercomarcal de l'Alt Penedes, Anoia i el Garraf, Spain
| | - Eva Ballesteros
- Servei de Radiologia, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Eduard Brunet-Mas
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Sabadell, Spain; CIBERehd, Instituto de Salud Carlos III, Spain.
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2
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Sidhu SS, Teh J. Arterial embolization during percutaneous vertebroplasty resulting in bilateral renal infarcts and ischemic colitis. Skeletal Radiol 2023; 52:1969-1974. [PMID: 36633644 DOI: 10.1007/s00256-022-04254-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 01/13/2023]
Abstract
This case report documents an arterial embolic event that occurred during vertebroplasty for a pathological compression fracture of T12 in a 54-year-old female with known metastatic breast carcinoma. A CT angiogram performed after the procedure demonstrated cement migration into the aorta, both kidneys, and the inferior mesenteric artery and its branches, with ischemic colitis involving the descending colon and sigmoid colon. A CT scan 4 months post-procedure demonstrated resolution of the colitis. Neovascularity and cortical destruction in malignant bone lesions are thought to contribute to arterial cement leak.
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Affiliation(s)
| | - James Teh
- Oxford University Hospitals, Oxford, UK
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Nassar A, Ben Abdallah I. Embolic Occlusion of the Inferior Mesenteric Artery Is a Cause of Ischaemic Colitis. Eur J Vasc Endovasc Surg 2023; 66:56. [PMID: 37087071 DOI: 10.1016/j.ejvs.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 04/24/2023]
Affiliation(s)
- Alexandra Nassar
- Department of Vascular and Thoracic surgery, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France.
| | - Iannis Ben Abdallah
- Department of Vascular and Thoracic surgery, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
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4
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Medas R, Santos AL, Ferreira M, Macedo G. Pneumatosis intestinalis: a rare endoscopic feature of colonic ischemia. Rev Esp Enferm Dig 2023; 115:385-386. [PMID: 35704358 DOI: 10.17235/reed.2022.8980/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A 71-year-old male was admitted on intensive care unit after endovascular aneurysm repair of ruptured infrarenal abdominal aortic aneurysm. 2 weeks later, he had multiple episodes of bloody diarrhea. Colonoscopy revealed diffuse dusky mucosal coloration with loss of vasculature pattern, diseased haustrations, and diffuse areas of pneumatosis, suggestive of severe colonic ischemia.
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Affiliation(s)
- Renato Medas
- Gastroenterology, Centro Hospitalar Universitário São João, Portugal
| | - Ana Luísa Santos
- Gastrenterology, Centro Hospitalar Universitário São João, Portugal
| | - Mariana Ferreira
- Gastroenterology, Sanatorio Municipal Dr. Julio Méndez, Argentina
| | - Guilherme Macedo
- Gastroenterology , Centro Hospitalar Universitário São João, Portugal
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5
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Fillias Q, Millet I, Guiu B, Orliac C, Curros Doyon F, Gamon L, Molinari N, Taourel P. Development and validation of a composite score to predict severe forms of ischemic colitis. Eur Radiol 2022; 32:6355-6366. [PMID: 35353197 DOI: 10.1007/s00330-022-08726-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop a simple scoring system in order to predict the risk of severe (death and/or surgery) ischemic colitis METHODS: In this retrospective study, 205 patients diagnosed with ischemic colitis in a tertiary hospital were consecutively included over a 6-year period. The study sample was sequentially divided into a training cohort (n = 103) and a validation cohort (n = 102). In the training cohort, multivariable analysis was used to identify clinical, biological, and CT variables associated with poor outcome and to build a risk scoring system. The discriminative ability of the score (sensitivity, specificity, positive predictive value, negative predictive value) was estimated in the two cohorts to externally validate the score, and a receiver operating characteristic curve was established to estimate the area under the curve of the score. Bootstrapping was used to validate the score internally. RESULTS In the training cohort, four independent variables were associated with unfavorable outcome: hemodynamic instability (2 pts), involvement of the small bowel (1 pt), paper-thin wall pattern (3 pts), no stratified enhancement pattern (1 pt). The score was used to categorize patients into low risk (score: 0, 1), high risk (score: 2-3), and very high risk (score: 4-7) groups with sensitivity and specificity of 97% and 67%, respectively, and a good discriminating capability, with a C-statistic of 0.94. Internal and external validation showed good discrimination capability (C-statistics of 0.9 and 0.84, respectively). CONCLUSION A simple risk score can stratify patients into three distinct prognosis groups, which can optimize patient management. CLINICAL TRIAL NUMBER NCT04662268 KEY POINTS: • Simple scoring system predicting the risk of severe ischemic colitis • First study to include CT findings to the clinical and biological data used to determine a severity score.
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Affiliation(s)
- Quentin Fillias
- Department of Imaging, Hospital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Ingrid Millet
- Department of Imaging, Hospital Lapeyronie, CHU Montpellier, Montpellier, France
- UMR 1302 Institute Desbrest of Epidemiology and Public Health, INSERM, University of Montpellier, Montpellier, France
| | - Boris Guiu
- Department of Imaging, Hospital Saint Eloi, CHU Montpellier, Montpellier, France
| | - Celine Orliac
- Department of Imaging, Hospital Lapeyronie, CHU Montpellier, Montpellier, France
| | | | - Lucie Gamon
- Department of Biostatistics, CHU Montpellier, Montpellier, France
| | - Nicolas Molinari
- UMR 1302 Institute Desbrest of Epidemiology and Public Health, INSERM, University of Montpellier, Montpellier, France
- Department of Biostatistics, CHU Montpellier, Montpellier, France
| | - Patrice Taourel
- Department of Imaging, Hospital Lapeyronie, CHU Montpellier, Montpellier, France.
- UMR 1302 Institute Desbrest of Epidemiology and Public Health, INSERM, University of Montpellier, Montpellier, France.
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Abstract
Colonoscopy is a risk factor for colon ischemia. The colon is susceptible to ischemia due to its minor blood flow compared to other abdominal organs; the etiology of colon ischemia after colonoscopy is multifactorial. The causative mechanisms include splanchnic circulation impairment, bowel preparation, drugs used for sedation, bowel wall ischemia due to insufflation/barotrauma, and introduction of the endoscope. Gastroenterologists must be aware of this condition and its risk factors for risk minimization, early diagnosis, and proper treatment.
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Affiliation(s)
- Sinan Sadalla
- Unità Operativa Complessa di Gastroenterologia e Endoscopia Digestiva, Università di Bologna/ Ospedale di Imola, Imola (BO) 40024, Italy
| | - Andrea Lisotti
- Unità Operativa Complessa di Gastroenterologia e Endoscopia Digestiva, Università di Bologna/ Ospedale di Imola, Imola (BO) 40026, Italy
| | - Lorenzo Fuccio
- Divisione di Gastroenterologia, Dipartimento di Scienze Medico-Chirurgiche (DIMEC), IRCSS- Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Pietro Fusaroli
- Unità Operativa Complessa di Gastroenterologia e Endoscopia Digestiva, Università di Bologna/ Ospedale di Imola, Imola (BO) 40026, Italy
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Affiliation(s)
- Soo In Choi
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, The Republic of Korea
| | - Jeongmin Choi
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, The Republic of Korea
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Affiliation(s)
- Tee Lin Goh
- Department of Gastroenterology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Jozef Lastik
- Department of Radiology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Rudi Schmigylski
- Department of Pathology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cubisino A, Schembri V, Guiu B. Inferior mesenteric arteriovenous fistula with colonic ischemia: a case report and review of the literature. Clin J Gastroenterol 2021; 14:1131-1135. [PMID: 33837935 DOI: 10.1007/s12328-021-01411-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
Inferior mesenteric arteriovenous fistula is a rare abnormal high flow communication with only 40 primary and secondary cases reported in literature. Shunting of arterial flow through the inferior mesenteric vein to the portal system can cause a variety of nonspecific clinical signs and symptoms usually associated with the diagnosis of arteriovenous malformation. Symptom intensities are flow-dependent and can range from minimal abdominal symptoms to severe heart failure due to left to right shunt. We report the case of a 72-year-old man without past history of abdominal surgery or trauma who was referred to our department for a 2-month history of intermittent diarrhea and abdominal pain caused by an arteriovenous fistula involving the left colic artery and the inferior mesenteric vein. A progressive and spontaneous improvement of symptoms and a control CT scan that confirmed the reduction of venous vascular engorgement and regression of parietal thickening of the left and sigmoid colon permitted a non-operative management.Inferior mesenteric arteriovenous fistula can be a rare cause of ischemic colitis and, if necessary, an appropriate treatment based on high clinical suspicion can reduce the risk of complications related to a missed diagnosis.
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Affiliation(s)
- Antonio Cubisino
- Division of HBP and Transplantation Surgery Unit, Department of Digestive Surgery and Transplantation, Saint-Eloi Hospital, University of Montpellier, 80 avenue Augustin Fliche, 34000, Montpellier, France.
| | - Valentina Schembri
- Department of Radiology, Saint-Eloi University Hospital, 80 Av. Augustin Fliche, 34000, Montpellier, France
| | - Boris Guiu
- Department of Radiology, Saint-Eloi University Hospital, 80 Av. Augustin Fliche, 34000, Montpellier, France
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11
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García Gavilán MC, Morales Alcázar F, Montes Aragón C, Sánchez Cantos AM. Ischemic colitis of the right colon after triathlon: the importance of high clinical suspicion. Gastroenterol Hepatol 2020; 44:565-566. [PMID: 33189408 DOI: 10.1016/j.gastrohep.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
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12
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Wen Y, Zhao M, Huang W, Fang S, Lin C. Idiopathic mesenteric phlebosclerosis associated with use of Chinese herbal medicine: Two case reports. Medicine (Baltimore) 2020; 99:e22813. [PMID: 33080758 PMCID: PMC7571907 DOI: 10.1097/md.0000000000022813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Idiopathic mesenteric phlebosclerosis (IMP) is a rare form of ischemic colitis. It is more common in the Asian population people with Asian ancestry. Disease pathogenesis and etiology are not fully elucidated but may be associated with the long-term intake of toxins and other substances, including Chinese herbs. The disease has typical radiological and endoscopic features. Radiologic examination combined with endoscopy can lead to a conclusive diagnosis. PATIENT CONCERNS We present 2 cases of IMP: in male patients aged 66 and 79 years. The first patient presented with diarrhea and abdominal pain, and the second patient presented with numbness of limbs and abdominal discomfort. These patients had a history of long-term use of Chinese herbal medicine (CHM). DIAGNOSIS Both patients were diagnosed with IMP by endoscopy and radiology, and the diagnosis confirmed by biopsy in the first patient. INTERVENTIONS The first patient was advised to stop using CHM. Both patients were given conservative treatment and were followed up regularly. OUTCOMES Symptoms improved after conservative treatment. The patients had no obvious discomfort during the follow-up period. CONCLUSION We suspect that the disease is induced by the long-term use of CHM, and dosage and duration of use may determine disease severity.
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Affiliation(s)
| | | | - Wei Huang
- Departments of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
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Affiliation(s)
- Ho Seung Kim
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
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14
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Killebrew SR, Patel NJ, Lam JP, Zhai Q, Lewis MD. It's not always cancer: ischemic colitis masquerading as a colonic mass. Gastrointest Endosc 2020; 91:954-955. [PMID: 31733198 DOI: 10.1016/j.gie.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/07/2019] [Indexed: 12/11/2022]
Affiliation(s)
| | - Neema J Patel
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jonathan P Lam
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - QiHui Zhai
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, USA
| | - Michele D Lewis
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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15
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Arai T, Yamada H, Edagawa T, Yoshida S, Hikimoto S, Sougawa H, Nakachi K. Association of decreased variation of coefficient R-R interval with ischemic colitis and small bowel obstruction. PLoS One 2020; 15:e0228117. [PMID: 32049965 PMCID: PMC7015401 DOI: 10.1371/journal.pone.0228117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/07/2020] [Indexed: 01/11/2023] Open
Abstract
Background The parasympathetic nervous system exerts and controls intestinal tone. Several studies have suggested that the coefficient of the R–R intervals (CVRR) is useful for evaluating the parasympathetic nervous system. Objectives This study aimed to evaluate the relationship between gastrointestinal emergencies, specifically ischemic colitis (IC) and small bowel obstruction (SBO), and the autonomic nervous system. Methods In this retrospective study, a total of 13 patients with IC or SBO aged ≧65 years were analyzed. CVRR was measured in patients with IC and SBO and controls. Results CVRR averaged to 8.8% ± 2.5% in controls, 1.4% ± 0.4% in patients with IC, and 2.4% ± 1.0% in SBO groups (p < 0.001). CVRR was significantly lower in patients with IC and SBO than that in controls. Conclusion The results of this study demonstrate the possibility that CVRR may serve as a clinical index for assessing the functioning of the parasympathetic nervous system in patients with IC or SBO.
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Affiliation(s)
- Toshio Arai
- Department of Gastroenterology, Hashimoto Municipal Hospital, Hashimoto, Wakayama, Japan
- * E-mail:
| | - Hiroki Yamada
- Department of Gastroenterology, Hashimoto Municipal Hospital, Hashimoto, Wakayama, Japan
| | - Takeya Edagawa
- Department of Gastroenterology, Hashimoto Municipal Hospital, Hashimoto, Wakayama, Japan
| | - Satoshi Yoshida
- Department of Gastroenterology, Hashimoto Municipal Hospital, Hashimoto, Wakayama, Japan
| | - Shigetoshi Hikimoto
- Department of Cardiology, Hashimoto Municipal Hospital, Hashimoto, Wakayama, Japan
| | - Hiromichi Sougawa
- Department of Cardiology, Hashimoto Municipal Hospital, Hashimoto, Wakayama, Japan
| | - Kenichiro Nakachi
- Department of Gastroenterology, Hashimoto Municipal Hospital, Hashimoto, Wakayama, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ku MC, Kok VC, Lee CK. An Unusual Cause of Ischemic Change of Long Segment of Colon. Gastroenterology 2017; 152:e12-e13. [PMID: 28384451 DOI: 10.1053/j.gastro.2016.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/27/2016] [Accepted: 09/30/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Ming-Chang Ku
- Department of Radiology, Kuang Tien General Hospital, Taichung, Taiwan; Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Victor C Kok
- Division of Medical Oncology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Chien-Kuan Lee
- Department of Pathology, Kuang Tien General Hospital, Taichung, Taiwan
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Affiliation(s)
- Lawrence J Brandt
- Division of Gastroenterology, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, New York, USA
| | - Paul Feuerstadt
- Gastroenterology Center of Connecticut, Hamden, Connecticut, USA
- Division of Digestive Disease, Yale University School of Medicine, New Haven, Connecticut, USA
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20
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Affiliation(s)
- Daniel Romeu Vilar
- Department of Radiology, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Galicia, Spain.
| | - Daniel López Rey
- Department of Radiology, Hospital da Costa, Burela, Lugo, Galicia, Spain.
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Sardari RRR, Struckmann H. [Ischaemic colitis secondary to emphysematous pyelonephritis]. Ugeskr Laeger 2015; 177:110-111. [PMID: 25612994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Emphysematous pyelonephritis is an acute severe necrotizing infection of the renal parenchyma and its surrounding tissues and up to 95% of the patients have diabetes. We describe a concurrent manifestation of emphysematous pyelonephritis and ischaemic colitis in a 51-year-old diabetic woman and conclude that the colitis was due to pressure from a large retroperitoneal mass and sepsis complications combined with underlying peripheral vascular disease because of diabetes mellitus and hypertension.
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22
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Gulstad MB, Thomsen H. [Ischaemic colitis after loperamide treatment]. Ugeskr Laeger 2015; 177:84-85. [PMID: 25612981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Ischaemic colitis is a potentially mortal illness which usually arises from decreased mesenteric blood flow. Loperamide is used in the treatment of both acute and chronic diarrhoea. We present a case of a 62-year-old man with no history of abdominal illness who was admitted with a distended and sore abdomen. Ten days prior to admission he was treated with loperamide. Because of his severe condition he had an emergency laparotomy which showed a necrotic colon and terminal ileum - both were resected. No thromboembolic cause was found and we therefore suggest loperamide as an inducing factor.
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Sherid M, Sifuentes H, Samo S, Sulaiman S, Husein H, Tupper R, Sethuraman SN, Spurr C, Vainder JA, Sridhar S. Ischemic colitis: A forgotten entity. Results of a retrospective study in 118 patients. J Dig Dis 2014; 15:606-13. [PMID: 25139520 DOI: 10.1111/1751-2980.12182] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of our study was to document our 6-year experiences in identifying the clinical characteristics, laboratory findings, risk factors and the outcomes of patients with ischemic colitis (IC) in a community hospital setting. METHODS The medical records of patients who were diagnosed with IC from 2007 to 2013 in two community hospitals were retrospectively reviewed. Their clinical characteristics, laboratory results, radiological, endoscopic and histological evidence, anatomic location of the lesion, comorbidities, concomitant use of drugs, and so on, were collected. RESULTS A total of 118 patients with IC was identified, most were elderly individuals with a female predominance. The most common symptoms were abdominal pain, rectal bleeding and diarrhea. Hypertension, hyperlipidemia, coronary artery disease and diabetes mellitus were the most common comorbidities. Erythema, edema and erosions/ulcerations were the most common endoscopic findings. Left colon was the most affected location of lesion (84.8%), and there was one case of pancolitis. The descending colon was the most common affected segment, while rectum was the least affected segment. Severe IC occurred in 12.7% of the patients. Death within 30 days from the diagnosis of the disease occurred in 4.2%. CONCLUSIONS IC is majorly occurred in elderly with a female predominance. Cardiovascular disease and its associated risk factors are the most common comorbidities. Left colon is the most affected location of the disease and the overall mortality rate was 4.2%. Physicians should make every effort to identify these patients, especially those with high risks.
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Affiliation(s)
- Muhammed Sherid
- Department of Internal Medicine, Division of Gastroenterology, CGH Medical Center, Sterling, Illinois, USA
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Sherid M, Sifuentes H, Samo S, Sulaiman S, Husein H, Tupper R, Spurr C, Vainder J, Sridhar S. Risk factors of recurrent ischemic colitis: a multicenter retrospective study. Korean J Gastroenterol 2014; 63:283-91. [PMID: 24870300 DOI: 10.4166/kjg.2014.63.5.283] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIMS Recurrence of ischemic colitis (IC) has not been studied extensively. The aim of this study was to investigate the characteristics of recurrent IC in the community setting and to identify any risk factors. METHODS We conducted a retrospective study in two community hospitals. Medical records of patients with IC from January 2007 to January 2013 were reviewed. Demographic details, clinical features, co- morbidities, concomitant use of medications,laboratory studies, imaging findings, endoscopic and histological features, surgery, hospital stay, and death within 30 days were collected. Patients were divided into two groups (recurrent IC group, non-recurrent IC group). RESULTS A total of 118 patients with IC were identified. IC recurred in 10 patients (8.5%) during the study period. Half of the patients in the recurrent IC group were current smokers as compared to only 18.7% of patients in the non-recurrent group. In the recurrent IC group, 20.0% of patients never smoked as compared to 61.7% in the non-recurrent group (p=0.027).Abdominal aortic aneurysm (AAA) was more frequent in the recurrent IC group (40.0% vs. 4.7%; p=0.003). No differences in other clinical symptoms, CT scan findings, comorbidities, endoscopic features, or use of concomitant medications were observed between the two groups. The need for surgical intervention, blood transfusion, intensive care unit stay, mechanical ventilation,length of hospital stay, and anatomic location of affected segments did not differ between the two groups. CONCLUSIONS IC recurred in 8.5% of patients during the six-year study period. Current smoking status and presence of AAA were identifying risk factors for recurrence of IC.
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Affiliation(s)
- Muhammed Sherid
- Division of Gastroenterology, Department of Internal Medicine, Georgia Regents University, 1120 15th Street, BB R2538, Augusta, GA 30912, USA
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25
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Wang HH, Wu YC, Liu CH, Chen YL, Huang GS, Chang WC. Mesenteric phlebosclerosis: an unexpected cause of abdominal pain. J Gastrointestin Liver Dis 2012; 21:344. [PMID: 23256112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Hong-Hau Wang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Republic of China
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26
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de la Villéon B, Goudard Y, de Chaumont A, Peroux E, Galeano C, Boulanger T. [Hepatic portal venous gas]. Rev Prat 2012; 62:452. [PMID: 22641876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Bruno de la Villéon
- Service de chirurgie viscérale et vasculaire, Hôpital d'instruction des armées du Val-de-Grâce, 75005 Paris.
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Beyrouti MI, Affes N, Hlel A, Fki I, Beyrouti R, Alimi H, Abid B, Ayadi L, Abelhedi C, Loukil I, Frikha F, Ben Amar M. [Ischemic acute colitis]. Tunis Med 2011; 89:876-877. [PMID: 22179912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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28
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Urlings TAJ, van Weel V, van der Linden E. [A woman with acute upper abdominal pain]. Ned Tijdschr Geneeskd 2011; 155:A3571. [PMID: 21771373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 42-year-old woman came to the emergency department with acute abdominal pain. CT-scan showed an isolated dissection of the A. mesenterica superior and signs of ischaemic colitis. The patient was treated with endovascular stent placement in the artery and partial small bowel resection.
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Affiliation(s)
- Thijs A J Urlings
- Medisch Centrum Haaglanden, Den Haag, Afd. Radiologie, the Netherlands.
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29
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Plackett TP, Coviello LC, Belnap CM, Phillips KJ, Gagliano RA, Sims CA. Intussusception and colonic ischemia in portal hypertension: a case report. Hawaii Med J 2010; 69:39-41. [PMID: 20358725 PMCID: PMC3104633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Intestinal intussusception is a relatively uncommon occurrence in adults in comparison to pediatric patients. While the management of intussusception in children is frequently decompression of the involved segment, adults often require surgical resection secondary to frequent association with neoplastic lead points. A less common reason for surgical removal of an intussuscepted segment in adults is the development of ischemic colitis. The authors present an unusual case of adult intussusception with associated ischemic colitis in a patient with portal hypertension awaiting liver transplantation. Portal hypertension is associated with the development of a microvascular colopathy This condition may serve as the lead point for intestinal intussusception. Furthermore, the vascular changes of portal hypertension leave the bowel unable to respond appropriately to the threat of ischemia. The colopathy of portal hypertension may have predisposed our patient to the development of colonic intussusception by submucosal vascular engorgement; it may have also rendered the intussuscepted segment more susceptible to the development of ischemia.
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30
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Türkvatan A, Ozdemir Akdur P, Akdoğan M, Cumhur T, Olçer T, Parlak E. Inferior mesenteric arteriovenous fistula with ischemic colitis: multidetector computed tomographic angiography for diagnosis. Turk J Gastroenterol 2009; 20:67-70. [PMID: 19330739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Inferior mesenteric arteriovenous fistula is rare and may be congenital or acquired. Two serious manifestations may occur in the course of the disease: portal hypertension and bowel ischemia. The diagnosis is generally established by conventional angiography. In this report, we present a case with multiple inferior mesenteric arteriovenous fistulas, considered idiopathic due to no known cause related to the etiology, and associated ischemic colitis, which were clearly demonstrated by multidetector computed tomographic angiography. We also review the available literature.
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Affiliation(s)
- Aysel Türkvatan
- Department of Radiology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey.
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31
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Tomita Y, Kin Y, Okamoto S, Oshima T, Hori K, Miwa H. [Phlebosclerotic enteritis]. Nihon Shokakibyo Gakkai Zasshi 2008; 105:583-586. [PMID: 18472449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Abstract
The incidence of acute mesenteric ischaemia has decreased over the last few years. However, cases of chronic mesenteric ischaemia have grown in number, as this disease is the most frequent disorder of the large intestine in the elderly. The typical clinical presentation of ischaemic colitis develops gradually and only becomes recognisable in the late stage of the disease. We present a 51-year-old woman with a history of unexplained abdominal pain. Multislice CT demonstrated an irregular stenosis of the truncus coeliacus and superior mesenteric artery. A Riolan's anastomosis was present and showed excellent perfusion. After a hemicolectomy 6 years previously, different radiologic procedures and endoscopy revealed a structural tumour at the colon transversum we suspected to be malignant. A sequential procedure was conducted. In a first vascular intervention, the truncus coeliacus was reconstructed with a vein patch, and the mesenteric superior artery was replanted. The second laparotomy was performed for revision of the superior mesenteric artery and resection of the intestinal tumour. However, no carcinoma was found in histological examination. In fact, the individual multidisciplinary considerations play an important role in determining the best treatment strategy, if intervention is warranted. Based on our experience, sequential intervention with a common clinical pathway is the safest and most suitable and economic procedure for curing complex pathologies.
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Affiliation(s)
- R Wilke
- Klinik für Allgemein- und Viszeralchirurgie, Klinikum Krefeld gGmbH, Lutherplatz 40, 47805 Krefeld.
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Abstract
The colon is affected by a number of diseases, mainly inflammatory, ischemic, and neoplastic conditions. Depending upon clinical indications endoscopy, US, CT, or other radiological methods are used for evaluation. The fact that US is frequently used as the initial imaging method in patients with non-specific clinical symptoms allows for greater influence in further diagnostic evaluation and with treatment, provided the investigator is familiar with the features of different intestinal diseases. This article will describe the anatomical characteristics of the colon, the US technique for examination of the colon, and the typical US features of the more common diagnoses of the colon.
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Affiliation(s)
- Alois Hollerweger
- Department of Radiology and Nuclear Medicine, Hospital Barmherzige Brüder, Kajetanerplatz 1, A-5020 Salzburg, Austria.
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34
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Affiliation(s)
- Marc A Mancuso
- Department of Radiology, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756, USA.
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35
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Bous JC, Tannapfel A, Henning BF. [Ischemic colitis without atherosclerosis?]. Dtsch Med Wochenschr 2007; 132:667-70. [PMID: 17377880 DOI: 10.1055/s-2007-973600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
HISTORY AND CLINICAL FINDINGS A 69-year-old woman, who was being treated for a bipolar affective psychosis, was admitted because of abdominal pain, emesis and bloody stool. EXAMINATIONS Blood tests showed increased inflammation parameters. Ultrasound revealed a swollen intestinal wall. Coloscopy correlated with the ultrasound findings and demonstrated an ischemic colitis. The histological report at first corroborated this as the possible diagnosis. But angiography of the mesenteric vessels and duplex ultrasound of the cervical vessels were normal. COURSE AND THERAPY: The symptoms persisted under therapy with acetylsalicylic acid (100 mg daily), no food intake and intravenous fluids. The coloscopic picture and the laboratory tests remained unchanged. The findings did not normalize until most of the antipsychotic drugs, especially perazine, were discontinued. The angiographic and duplexultrasound results spoke against the initially suspected diagnosis of an ischemic origin, but for necrotizing colitis as an adverse effect of perazine. A second biopsy confirmed this explanation. CONCLUSION A necrotizing colitis as an adverse effect of drugs can simulate an ischemic colitis on endoscopy and in a biopsy. Even if the clinical pattern is present possible adverse reaction to the medication should be considered. The diagnosis of a necrotizing colitis was postulated only after the course of the disease had been taken into account and, in particular, atherosclerosis had been excluded as a possible cause, and an adverse reaction to the medication had been considered.
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Affiliation(s)
- J C Bous
- Marienhospital Herne, Klinikum der Ruhr-Universität Bochum, Medizinische Klinik I, Bochum
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36
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Affiliation(s)
- Y Sumitomo
- Department of Gastroenterology, Kuno Hospital, Kyoto, Japan
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37
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Legrand M, Lecuyer L, Van De Louw A. [Colonic necrosis following a pancreatic pseudocyst embolization]. ACTA ACUST UNITED AC 2006; 26:161-3. [PMID: 17174520 DOI: 10.1016/j.annfar.2006.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Accepted: 10/11/2006] [Indexed: 11/26/2022]
Abstract
A 43-year-old man with chronic alcohol pancreatitis was admitted in our intensive care unit for an haemorrhagic shock. An abdominal CT-scan performed on admission showed bleeding from a vessel in a pancreatic pseudocyst. Initial treatment included intravenous fluids, transfusion, mechanical ventilation and vasopressive support. Percutaneous arterial embolization (PAE) of a bleeding right superior colon artery was performed with an initial good result. Nevertheless after initial clinical improvement, hypotension refractory to fluid management occurred. An abdominal CT-scan disclosed pneumatosis in right colon. A right hemicolectomy was performed. Histologic analysis confirmed ischemic colitis. The patient recovered and was discharged from the intensive care unit. Colitis necrosis after PAE for pancreatic pseudoaneurysm had never been described before. It should be suspected when haemodynamic instability occurs following PAE.
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MESH Headings
- Adult
- Aneurysm, False/complications
- Aneurysm, False/therapy
- Chronic Disease
- Colectomy/methods
- Colitis, Ischemic/diagnostic imaging
- Colitis, Ischemic/etiology
- Colitis, Ischemic/surgery
- Colon/blood supply
- Colon/pathology
- Combined Modality Therapy
- Embolization, Therapeutic/adverse effects
- Erythrocyte Transfusion
- Fluid Therapy
- Gelatin/adverse effects
- Gelatin Sponge, Absorbable/administration & dosage
- Gelatin Sponge, Absorbable/adverse effects
- Gram-Positive Bacterial Infections/etiology
- Gram-Positive Bacterial Infections/microbiology
- Humans
- Hypotension/etiology
- Hypotension/therapy
- Lactobacillus
- Male
- Necrosis
- Pancreatic Pseudocyst/complications
- Pancreatic Pseudocyst/therapy
- Pancreatitis, Alcoholic/complications
- Peritonitis/etiology
- Peritonitis/microbiology
- Plasma
- Rupture, Spontaneous
- Shock, Hemorrhagic/etiology
- Tachycardia/etiology
- Tachycardia/therapy
- Tomography, X-Ray Computed
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Affiliation(s)
- M Legrand
- Service de réanimation polyvalente, centre hospitalier Sud-Francilien, quartier du Canal, 91014 Evry cedex, France.
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38
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Schneider JA, White EA, Welch DC, Stokes LS, Raiford DS. Transjugular intrahepatic portosystemic shunt for treatment of intractable colonic ischemia associated with portal hypertension: a bridge to liver transplantation. Liver Transpl 2006; 12:1540-3. [PMID: 17004262 DOI: 10.1002/lt.20860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 64-year-old man with portal hypertension secondary to hepatic nodular transformation was awaiting liver transplantation when he presented with severe, unrelenting abdominal pain, fever, and hypotension. Computed tomographyrevealed pneumatosis within the cecum and ascending colon. Because of his advanced liver disease and the perceived high likelihood of a poor outcome after colonic resection, he was managed medically. He improved initially but had a lengthy hospital course notable for intractable intestinal ischemia and gastrointestinal bleeding. Magnetic resonance angiography demonstrated patent mesenteric, portal, and hepatic vessels. His blood pressure was typically 90/55 mm Hg (mean arterial pressure, 65-70 mm Hg) despite intravenous fluids and blood product replacement. The hypothesis developed that the patient's level of portal hypertension was sufficiently severe (in the face of his low mean systemic arterial pressure) to compromise perfusion of the colonic mucosa. Were this hypothesis correct, then portal decompression might enhance the blood pressure gradient across the bowel and improve mucosal perfusion. With this in mind, a transjugular intrahepatic portosystemic shunt (TIPS) was placed. There was reduction of the portal vein to inferior vena cava gradient from 29 mm Hg to 9 mm Hg and his abdominal pain and gastrointestinal bleeding ceased. His prompt and sustained improvement following TIPS shunt placement is consistent with the hypothesis that high portal pressure was flow limiting, thus contributing to persisting intestinal ischemia. This case represents the first report of use of a TIPS shunt to address colonic ischemia associated with portal hypertension.
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Affiliation(s)
- Jonathan A Schneider
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-5280, USA
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39
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Abstract
A 76-year-old man with an abdominal aortic aneurysm (AAA) initially presented with ischemic colitis, which was improved by conservative treatment. Preoperative assessment by computerized axial tomography scanning and aortography revealed an infrarenal type AAA with mural thrombus, stenoses of the right common iliac artery and the left internal iliac artery. The patient underwent aortoiliac bypass surgery with resection of the stenoses, and reconstruction of the left internal iliac artery. No complications including bowel ischemia, were noted postoperatively. This case emphasized the potential benefits of the extraperitoneal approach to the aorta, reconstruction of both internal iliac arteries, and use of prostaglandin E1.
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Affiliation(s)
- S Tatebe
- Departments of Thoracic and Cardiovascular Surgery, Mito Saiseikai General Hospital, Mito City, Japan.
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40
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Schellhammer F, Krömeke O, Poll L, Fürst G, Mödder U. [Nonocclusive ischemia of the right colon]. Radiologe 2006; 47:721-4. [PMID: 16541274 DOI: 10.1007/s00117-005-1331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nonocclusive disease (NOD) is known to be a common cause of ischemic colitis, which is frequently underestimated. MATERIAL AND METHODS A computer-assisted search of radiological reports at our institute over a period of 18 months, describing ischemic colitis of the ascending colon with an unimpaired perfusion of the superior mesenteric artery, was performed. RESULTS A retrospective analysis of the clinical and radiological data of 14 patients was performed. In ten cases colonic ischemia was confirmed clinically or intraoperatively. Most of our patients needed intravenous catecholamines due to severe hypotension. However, no significant radiographic predictors could be identified. CONCLUSION Awareness of NOD seems to be crucial. Especially in cases of acute abdominal pain associated with severe hypotension, renal insufficiency, or pancreatitis, one should include NOD as a differential diagnosis at an early stage.
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Affiliation(s)
- F Schellhammer
- Institut für diagnostische Radiologie, Heinrich-Heine-Universität, Moorenstrasse 5, 40225 Düsseldorf, Germany.
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41
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Abstract
A spectrum of lower gastrointestinal tract symptoms occurs in marathon runners. Although most symptoms are transient, reversible ischemic colitis is a rare complication that typically responds to supportive therapy. Because computed tomographic features have not been previously described to our knowledge, we describe abdominal computed tomographic manifestations of reversible ischemic colitis in three marathon runners. On computed tomography, reversible ischemic colitis involves the cecum, with varying involvement of the proximal colon.
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Affiliation(s)
- R Kyriakos
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
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Abstract
OBJECTIVE The objective of this study was to analyze the imaging findings of phlebosclerotic colitis in comparison with histologic findings. CONCLUSION Calcifications and/or obstructions of the veins of the colonic wall and adjacent mesentery and collateral formation, edematous thickening of the colonic wall, and increased density in the fatty tissue of the surrounding mesentery were features of this rare entity. However, in the early stage of the disease, no definite calcification of the affected veins was observed.
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Affiliation(s)
- Miho Kusanagi
- Department of Radiology, Kanazawa University Graduate School of Medical Science, Takaramachi, Kanazawa 920-8641, Japan
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Grimaldi T, Barbieri A, Ratti C, Ligabue G, Romagnoli R, Modena MG. Non-invasive diagnosis of acute ischemic bowel disease detected as hepatic portal venous gas during intra-aortic balloon percutaneous counterpulsation. Ital Heart J 2005; 6:610-1. [PMID: 16274027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The authors report a very unusual case of non-invasive diagnosis of acute ischemic bowel disease detected as hepatic portal venous gas during intra-aortic balloon percutaneous counterpulsation. A 64-year-old man with acute ST-elevation myocardial infarction complicated by cardiogenic shock was treated with percutaneous angioplasty and intra-aortic balloon percutaneous counterpulsation. The post-procedural period was complicated by severe abdominal pain. Abdominal computed tomography revealed hepatic portal venous gas. Multiple kidney and splenic ischemic areas were also identified. Colonoscopy showed signs referring to acute ischemic colitis. Computed tomography detection of hepatic portal venous gas has permitted the non-invasive diagnosis of bowel necrosis.
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Affiliation(s)
- Teresa Grimaldi
- Institute of Cardiology, Modena and Reggio Emilia University School of Medicine, Policlinico Hospital, Modena, Italy
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44
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Eriksen R. [Ultrasonography in acute transient ischaemic colitis]. Tidsskr Nor Laegeforen 2005; 125:1314-6. [PMID: 15909000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Acute transient ischaemic colitis gives abdominal pain and blood per rectum; the symptoms disappear in the course of a few days. The diagnosis is made by clinical signs and symptoms, endoscopy and histology. MATERIAL AND METHODS During the last tree years this diagnosis has been made in 12 patients in our department. In an attempt at evaluating the extent to which transabdominal ultrasonography could give diagnostic information, the patients were examined in the acute state and at control a few days later; then the data were compared. RESULTS At admission the bowel wall echotexture was non-stratified; proximal to the ischaemic damage was fluid or air within the bowel lumen in all patients. During the observation period the thickness of the bowel wall was reduced from 9.0 +/- 1.7 to 4.2 +/- 0.7 mm (p < 0.0005). At the same time, mural resistive index was reduced from 0.72 +/- 0.08 to 0.62 +/- 0.09 (p = 0.010), while systolic acceleration time was reduced from 0.144 +/- 0.054 to 0.070 +/- 0.023 ms (p = 0.001), the same value as was found in the great mesenteric vessels (p = 0.969). INTERPRETATION In acute transient ischaemic colitis, transabdominal ultrasonography may reveal pathological haemodynamic conditions and bowel wall thickness, both of which normalise within a few days.
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Affiliation(s)
- Ragnar Eriksen
- Medisinsk avdeling, Gastroenterologisk seksjon, Alesund sjukehus, 6026 Alesund.
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45
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Abstract
OBJECTIVE The purpose of this study was to describe the sonographic findings of 58 patients with proven ischemic colitis and to evaluate whether any of the findings are related to the presence or development of transmural necrosis. MATERIALS AND METHODS We reviewed the histories of patients diagnosed with ischemic colitis over a period of 5.5 years. Sixty-two patients had undergone sonographic examinations. The spectrum of sonographic findings in ischemic colitis was based on the original imaging report, with an analysis of the presence of colonic abnormalities and their associated alterations. In the second part of the study, we divided the patients into two groups according to the presence or absence of transmural necrosis, and the sonographic findings of each group were compared. Ten patients had sonographic follow-up studies during their hospital stay. RESULTS The prospective sensitivity of sonography for the characterization of colonic abnormalities was 93.5% (58/62 patients). Segmental involvement was detected in 57 of the 58 patients, with left-sided colitis in 47 (81%). The mean length of bowel involved was 19 cm, with a mean wall thickness of 7.6 mm. Colon wall stratification was preserved in 38 patients (66%). Altered pericolic fat was observed in 16 patients (28%). Absence of or barely visible color Doppler flow in the thickened bowel wall was recorded in 80% of patients. Altered pericolic fat was the only sonographic variable significantly associated with the presence of transmural necrosis (p = 0.004). Improvement as assessed on sonography was observed in all patients with a good clinical course. In patients with transmural necrosis, sonography did not show improvement. CONCLUSION Sonography is a valuable technique for the detection of colonic abnormalities resulting from ischemic colitis. In this study, altered pericolic fat or the absence of improvement in sonographic follow-up studies were factors associated with transmural necrosis.
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Affiliation(s)
- Tomás Ripollés
- Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Ave., Valencia 46017, Spain.
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46
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Abstract
A 48-year-old woman presented with bloody diarrhea, exsiccosis, abdominal pain and fever. A CT-scan showed air inclusions and thickening of the colonic wall. Laparotomy revealed partial necrosis of the colonic wall from the cecum to the rectosigmoid junction. After colectomy with ileorectostomy recovery was uneventful. The histological examination showed erosions, ulcerations, necrosis and some abscesses along the colonic wall which were not typical for ulcerative colitis or Crohn's disease. The patient reported medication with diclofenac for rheumatoid arthritis. The most probable diagnosis was NSAID-induced colitis. That NSAID may cause colitis has often been described in literature, but there have been only few records on nearly total colon necrosis.
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Affiliation(s)
- B Ablassmaier
- Abteilung für Allgemein- und Visceralchirurgie, St. Marienkrankenhaus Berlin-Lankwitz.
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47
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Affiliation(s)
- B Mesurolle
- Service de radiologie, Centre de santé universitaire McGill, Hôpital Royal Victoria, Montréal, QC, Canada.
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48
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Affiliation(s)
- Bryan T Green
- Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina 27710, USA
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49
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Abstract
PURPOSE Nonthrombotic stenosis or occlusion of the mesenteric veins is a rare cause of intestinal ischemia. The aim of this study was to describe a new disease entity causing chronic ischemic colitis. METHODS Seven patients were diagnosed as having mesenteric phlebosclerosis. All seven patients had calcifications in the small mesenteric veins and their intramural branches. No evidence of vasculitis or portal hypertension was recognized. None of the patients had a history of gastrointestinal disease or of prolonged drug use. We report clinical, laboratory, radiographic, endoscopic, and histopathologic findings. RESULTS Clinical findings included abdominal pain and diarrhea of a gradual onset and chronic course. A positive fecal occult blood test and mild anemia were often found. The patients had linear calcifications and stenosis in the right colon, which were discovered by plain abdominal radiography and barium enema, respectively. Endoscopic findings included edematous, dark colored mucosa and ulcerations. Four patients underwent a subtotal colectomy because of persistent abdominal pain or ileus. The histopathologic findings were macroscopically characterized by a dark purple or dark brown colored colonic surface, the swelling and disappearance of plicae semilunares coli, and marked thickening of the colonic wall, while they were microscopically characterized by marked fibrous thickening of the venous walls with calcifications, marked submucosal fibrosis, deposition of collagen in the mucosa, and foamy macrophages within the vessel walls. CONCLUSIONS These peculiar lesions have not previously been fully described. The cause and pathogenesis still remain unknown. We conclude that such lesions represent a new clinicopathologic disease entity and propose the term "idiopathic mesenteric phlebosclerosis."
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Affiliation(s)
- Akinori Iwashita
- Department of Pathology, Fukuoka University, Chikushi Hospital, Fukuoka-ken, Japan
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Kamihira M, Nojiri Y, Hirakawa R, Fujiwara T, Imawari M. [A case of ischemic colitis with four episodes of attack]. Nihon Shokakibyo Gakkai Zasshi 2002; 99:1075-8. [PMID: 12355895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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