Ischemic colitis natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
Ischemic colitis can span a wide spectrum of severity | Ischemic colitis can span a wide spectrum of severity. Majority of patients are treated supportively and recover fully, while a minority with very severe ischemia may develop [[sepsis]] and become critically ill.<ref>{{cite journal | author = Medina C, Vilaseca J, Videla S, Fabra R, Armengol-Miro J, Malagelada J | title = Outcome of patients with ischemic colitis: review of fifty-three cases. | journal = Dis Colon Rectum | volume = 47 | issue = 2 | pages = 180-4 | year = 2004 | id = PMID 15043287}}</ref> Most patients make a full recovery. Occasionally, after severe ischemia, patients may develop long-term complications such as a [[stricture]]<ref>{{cite journal | author = Simi M, Pietroletti R, Navarra L, Leardi S | title = Bowel stricture due to ischemic colitis: report of three cases requiring surgery. | journal = Hepatogastroenterology | volume = 42 | issue = 3 | pages = 279-81 | year = 1995 | id = PMID 7590579}}</ref> or chronic colitis.<ref>{{cite journal | author = Cappell M | title = Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia. | journal = Gastroenterol Clin North Am | volume = 27 | issue = 4 | pages = 827-60, vi | year = 1998 | id = PMID 9890115}}</ref> | ||
==Natural History== | ==Natural History== | ||
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==Complications== | ==Complications== | ||
* About 20% of patients with acute ischemic colitis may develop a long-term complication known as chronic ischemic colitis.<ref>{{cite journal | author = Cappell M | title = Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia. | journal = Gastroenterol Clin North Am | volume = 27 | issue = 4 | pages = 827-60, vi | year = 1998 | id = PMID 9890115}}</ref> Symptoms can include recurrent infections, [[bloody diarrhea]], [[weight loss]], and chronic [[abdominal pain]]. Chronic ischemic colitis is often treated with surgical removal of the chronically diseased portion of the bowel. | |||
* A [[stricture|colonic stricture]] is a band of scar tissue which forms as a result of the ischemic injury and narrows the [[lumen (anatomy)|lumen]] of the colon. [[Strictures]] are often treated observantly; they may heal spontaneously over 12-24 months. If a [[bowel obstruction]] develops as a result of the stricture, surgical [[resection]] is the usual treatment,<ref>{{cite journal | author = Simi M, Pietroletti R, Navarra L, Leardi S | title = Bowel stricture due to ischemic colitis: report of three cases requiring surgery. | journal = Hepatogastroenterology | volume = 42 | issue = 3 | pages = 279-81 | year = 1995 | id = PMID 7590579}}</ref> although endoscopic dilatation and [[stent]]ing have also been employed.<ref>{{cite journal | author = Oz M, Forde K | title = Endoscopic alternatives in the management of colonic strictures. | journal = Surgery | volume = 108 | issue = 3 | pages = 513-9 | year = 1990 | id = PMID 2396196}}</ref><ref>{{cite journal | author = Profili S, Bifulco V, Meloni G, Demelas L, Niolu P, Manzoni M | title = [A case of ischemic stenosis of the colon-sigmoid treated with [[Self-expandable metallic stent|self-expandable uncoated metallic prosthesis]]] | journal = Radiol Med (Torino) | volume = 91 | issue = 5 | pages = 665-7 | year = 1996 | id = PMID 8693144}}</ref> | |||
A [[stricture|colonic stricture]] is a band of scar tissue which forms as a result of the ischemic injury and narrows the [[lumen (anatomy)|lumen]] of the colon. [[Strictures]] are often treated observantly; they may heal spontaneously over 12-24 months. If a [[bowel obstruction]] develops as a result of the stricture, surgical resection is the usual treatment,<ref>{{cite journal | author = Simi M, Pietroletti R, Navarra L, Leardi S | title = Bowel stricture due to ischemic colitis: report of three cases requiring surgery. | journal = Hepatogastroenterology | volume = 42 | issue = 3 | pages = 279-81 | year = 1995 | id = PMID 7590579}}</ref> although endoscopic dilatation and [[stent]]ing have also been employed.<ref>{{cite journal | author = Oz M, Forde K | title = Endoscopic alternatives in the management of colonic strictures. | journal = Surgery | volume = 108 | issue = 3 | pages = 513-9 | year = 1990 | id = PMID 2396196}}</ref><ref>{{cite journal | author = Profili S, Bifulco V, Meloni G, Demelas L, Niolu P, Manzoni M | title = [A case of ischemic stenosis of the colon-sigmoid treated with [[Self-expandable metallic stent|self-expandable uncoated metallic prosthesis]]] | journal = Radiol Med (Torino) | volume = 91 | issue = 5 | pages = 665-7 | year = 1996 | id = PMID 8693144}}</ref> | |||
==Prognosis== | ==Prognosis== | ||
* Majority of patients with ischemic colitis recovery fully, although the prognosis depends on the severity of the ischemia. | |||
* Patients with pre-existing [[peripheral vascular disease]] or ischemia of the ascending (right) [[colon]] may be at increased risk for complications or death. | |||
Non-[[gangrenous]] ischemic colitis, which comprises the | * Non-[[gangrenous]] ischemic colitis, which comprises the majority of cases, is associated with a mortality rate of approximately 6%.<ref>{{cite journal | author = Longo W, Ballantyne G, Gusberg R | title = Ischemic colitis: patterns and prognosis. | journal = Dis Colon Rectum | volume = 35 | issue = 8 | pages = 726-30 | year = 1992 | id = PMID 1643995}}</ref> However, the minority of patients who develop [[gangrene]] as a result of colonic ischemia have a mortality rate of 50-75% with surgical treatment; the mortality rate is almost 100% without surgical intervention.<ref>{{cite journal | author = Parish K, Chapman W, Williams L | title = Ischemic colitis. An ever-changing spectrum? | journal = Am Surg | volume = 57 | issue = 2 | pages = 118-21 | year = 1991 | id = PMID 1992867}}</ref> | ||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Ischemic colitis can span a wide spectrum of severity. Majority of patients are treated supportively and recover fully, while a minority with very severe ischemia may develop sepsis and become critically ill.[1] Most patients make a full recovery. Occasionally, after severe ischemia, patients may develop long-term complications such as a stricture[2] or chronic colitis.[3]
Natural History
Three progressive phases of ischemic colitis have been described:[4][5]
- A hyperactive phase occurs first, in which the primary symptoms are severe abdominal pain and the passage of bloody stools. Many patients get better and do not progress beyond this phase.
- A paralytic phase can follow if ischemia continues; in this phase, the abdominal pain becomes more widespread, the belly becomes more tender to the touch, and bowel motility decreases, resulting in abdominal bloating, no further bloody stools, and absent bowel sounds on exam.
- Finally, a shock phase can develop as fluids start to leak through the damaged colon lining. This can result in shock and metabolic acidosis with dehydration, low blood pressure, rapid heart rate, and confusion. Patients who progress to this phase are often critically ill and require intensive care.
Complications
- About 20% of patients with acute ischemic colitis may develop a long-term complication known as chronic ischemic colitis.[6] Symptoms can include recurrent infections, bloody diarrhea, weight loss, and chronic abdominal pain. Chronic ischemic colitis is often treated with surgical removal of the chronically diseased portion of the bowel.
- A colonic stricture is a band of scar tissue which forms as a result of the ischemic injury and narrows the lumen of the colon. Strictures are often treated observantly; they may heal spontaneously over 12-24 months. If a bowel obstruction develops as a result of the stricture, surgical resection is the usual treatment,[7] although endoscopic dilatation and stenting have also been employed.[8][9]
Prognosis
- Majority of patients with ischemic colitis recovery fully, although the prognosis depends on the severity of the ischemia.
- Patients with pre-existing peripheral vascular disease or ischemia of the ascending (right) colon may be at increased risk for complications or death.
- Non-gangrenous ischemic colitis, which comprises the majority of cases, is associated with a mortality rate of approximately 6%.[10] However, the minority of patients who develop gangrene as a result of colonic ischemia have a mortality rate of 50-75% with surgical treatment; the mortality rate is almost 100% without surgical intervention.[11]
References
- ↑ Medina C, Vilaseca J, Videla S, Fabra R, Armengol-Miro J, Malagelada J (2004). "Outcome of patients with ischemic colitis: review of fifty-three cases". Dis Colon Rectum. 47 (2): 180–4. PMID 15043287.
- ↑ Simi M, Pietroletti R, Navarra L, Leardi S (1995). "Bowel stricture due to ischemic colitis: report of three cases requiring surgery". Hepatogastroenterology. 42 (3): 279–81. PMID 7590579.
- ↑ Cappell M (1998). "Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia". Gastroenterol Clin North Am. 27 (4): 827–60, vi. PMID 9890115.
- ↑ Boley, SJ, Brandt, LJ, Veith, FJ. Ischemic disorders of the intestines. Curr Probl Surg 1978; 15:1.
- ↑ Hunter G, Guernsey J (1988). "Mesenteric ischemia". Med Clin North Am. 72 (5): 1091–115. PMID 3045452.
- ↑ Cappell M (1998). "Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia". Gastroenterol Clin North Am. 27 (4): 827–60, vi. PMID 9890115.
- ↑ Simi M, Pietroletti R, Navarra L, Leardi S (1995). "Bowel stricture due to ischemic colitis: report of three cases requiring surgery". Hepatogastroenterology. 42 (3): 279–81. PMID 7590579.
- ↑ Oz M, Forde K (1990). "Endoscopic alternatives in the management of colonic strictures". Surgery. 108 (3): 513–9. PMID 2396196.
- ↑ Profili S, Bifulco V, Meloni G, Demelas L, Niolu P, Manzoni M (1996). "self-expandable uncoated metallic prosthesis". Radiol Med (Torino). 91 (5): 665–7. PMID 8693144.
- ↑ Longo W, Ballantyne G, Gusberg R (1992). "Ischemic colitis: patterns and prognosis". Dis Colon Rectum. 35 (8): 726–30. PMID 1643995.
- ↑ Parish K, Chapman W, Williams L (1991). "Ischemic colitis. An ever-changing spectrum?". Am Surg. 57 (2): 118–21. PMID 1992867.