Ischemic colitis natural history, complications and prognosis: Difference between revisions
Jump to navigation
Jump to search
Hamid Qazi (talk | contribs) No edit summary |
Hamid Qazi (talk | contribs) |
||
| Line 23: | Line 23: | ||
==Complications== | ==Complications== | ||
The complications of ischemic colitis are as follows:<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><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><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> | The complications of ischemic colitis are as follows:<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><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><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> | ||
* About 20% of patients with acute ischemic colitis may develop a long-term complication known as chronic ischemic colitis. 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. | * About 20% of patients with acute ischemic colitis may develop a long-term complication known as chronic ischemic colitis. | ||
** 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 although endoscopic dilatation and [[stent]]ing have also been employed. | * 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 although endoscopic dilatation and [[stent]]ing have also been employed. | |||
==Prognosis== | ==Prognosis== | ||
Revision as of 14:42, 3 January 2018
|
Ischemic colitis Microchapters |
|
Case Studies |
|
Ischemic colitis natural history, complications and prognosis On the Web |
|
American Roentgen Ray Society Images of Ischemic colitis natural history, complications and prognosis |
|
FDA onIschemic colitis natural history, complications and prognosis |
|
CDC on Ischemic colitis natural history, complications and prognosis |
|
Ischemic colitis natural history, complications and prognosis in the news |
|
Blogs on Ischemic colitis natural history, complications and prognosis |
|
Risk calculators and risk factors for Ischemic colitis natural history, complications and prognosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2] Cafer Zorkun, M.D., Ph.D. [3]
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. Most patients make a full recovery. Occasionally, after severe ischemia, patients may develop long-term complications such as a stricture or chronic colitis.
Natural History
Three progressive phases of ischemic colitis have been described:[1][2][3][4][5]
- Hyperactive phase occurs first
- Primary symptoms are severe abdominal pain and the passage of bloody stools.
- Many patients get better and do not progress beyond this phase.
- Paralytic phase can follow if ischemia continues
- 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.
- Shock phase can develop as fluids start to leak through the damaged colon lining.
- Results 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
The complications of ischemic colitis are as follows:[6][7][8][9]
- About 20% of patients with acute ischemic colitis may develop a long-term complication known as chronic ischemic colitis.
- 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 although endoscopic dilatation and stenting have also been employed.
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.
- ↑ 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.
- ↑ 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.