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Hu M, Fang H, Hu Y, Lu C, Chen Y, Zhong Z, Shi H, Wang Q. An Unusual Cause of Intestinal Ulcers Masquerading as Inflammatory Bowel Disease: A Case Report of Allied Disorders of Hirschsprung's Disease. J Inflamm Res 2024; 17:3093-3099. [PMID: 38779428 PMCID: PMC11110832 DOI: 10.2147/jir.s459548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Background Allied disorders of Hirschsprung's disease (ADHD) exhibit symptoms akin to those of Hirschsprung's disease, primarily characterized by intestinal obstruction, bowel dilatation, and chronic constipation. The occurrence of amyloid complications in patients with ADHD is infrequent. In this report, we present a case of ADHD with intestinal ulcers as the initial gastrointestinal manifestation, and subsequent pathological examination revealed the presence of amyloid deposits in the colonic mucosa. Case Report A male patient, aged 20, exhibited recurring abdominal distension and intestinal obstruction for a duration of three years. Multiple colonoscopies revealed the presence of recurrent colonic ulcers, with pathological examination indicating the existence of amyloid deposits within the mucosal layer of the colon. Abdominal CT scans suggested colonic dilatation. Following a multidisciplinary consultation, a subtotal resection of the colon was performed, and subsequent postoperative pathology confirmed a decrease and absence of myenteric plexus ganglion cells. Considering the patient's symptoms and the findings from the postoperative pathology, a diagnosis of ADHD was made. The patient's symptoms resolved postoperatively and he was discharged from the hospital and followed up for 1 year in stable condition. Conclusion Our study highlights the potential association between ADHD and the initial presentation of recurrent colonic ulcers, accompanied by amyloid deposition in the intestinal mucosa. This finding suggests a possible pathogenic mechanism for ADHD and offers a novel perspective on its diagnosis.
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Affiliation(s)
- Minli Hu
- Department of Gastroenterology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, People’s Republic of China
| | - Hao Fang
- Department of Traumatology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, People’s Republic of China
| | - Yibing Hu
- Department of Gastroenterology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, People’s Republic of China
| | - Chong Lu
- Department of Gastroenterology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, People’s Republic of China
| | - Yuan Chen
- Department of Gastroenterology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, People’s Republic of China
| | - Zhifeng Zhong
- Department of Anus & Intestine Surgery, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, People’s Republic of China
| | - Hongqi Shi
- Department of Pathology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, People’s Republic of China
| | - Qunying Wang
- Department of Gastroenterology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, People’s Republic of China
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Inayat F, Saeed A, Taj S, Kulsoom S, Rehman AU, Amin MK, Akhtar Z, Haq ZU. Acute Ischemic Colitis Associated With Oral Phenylephrine Use: A Rare Adverse Effect of a Common Over-the-Counter Drug. Am J Ther 2024; 31:e320-e322. [PMID: 37155143 DOI: 10.1097/mjt.0000000000001635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
| | | | - Sobaan Taj
- Jersey Shore University Medical Center, Neptune, NJ
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3
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Acosta S, Coopersmith CM, Reintam Blaser A. Nomenclature issues: non-occlusive mesenteric ischaemia and colon ischaemia. Intensive Care Med 2024:10.1007/s00134-024-07447-y. [PMID: 38656361 DOI: 10.1007/s00134-024-07447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Stefan Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Craig M Coopersmith
- Department of Surgery and Emory Critical Care Center, Emory University, Atlanta, GA, USA
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
- Intensive Care Unit, Lucerne Cantonal Hospital, Lucerne, Switzerland.
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4
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Stephan F, Facque M, Salem FB, Picq O, Imbert A, Genty T, Zins M. Probabilistic Prediction of Gastrointestinal Ischemia after Cardiothoracic Surgery. Thorac Cardiovasc Surg 2024. [PMID: 38513707 DOI: 10.1055/a-2292-0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Gastrointestinal ischemia (GIisch) is challenging to diagnose in patients after cardiothoracic surgery. Computed tomography angiography (CTA) carries substantial false-negative and false-positive rates. The aim of the study was to evaluate if a combination of readily available variables improves the diagnosis of GIisch after cardiothoracic surgery. METHODS This retrospective study included patients receiving intensive care after cardiothoracic surgery. GIisch was confirmed by surgical and/or endoscopic findings. A GIisch prediction score was developed using the Spiegelhalter-Knill-Jones system in a training cohort then tested in a validation cohort (patients without obvious signs of GIisch on CTA). RESULTS The training cohort comprised 125 consecutive patients with suspected GIisch in 2008 to 2019, including 85 with confirmed GIisch. CTA, performed in 92 patients, had a high false-negative rate of 17/60 (28%) and a lower false-positive rate of 7/32 (22%). The score included cardiopulmonary bypass, negatively associated with GIisch, and six variables positively associated with GIisch: intraoperative mean arterial pressure < 50 mm Hg, aspartate aminotransferase > 15 N, lactate increase in 24 hour > 20%, and 3 CTA findings, namely, bowel dilation, bowel wall thickening, and mesenteric vasoconstriction. The area under the receiver operating characteristic was 0.82 (95% confidence interval [CI], 0.51-0.93) in the training cohort and 0.82 (95% CI, 0.68-0.96) in the validation cohort (n = 34 patients). Reliability of the predicted probabilities was greatest for probabilities ≤ 30% or ≥ 70%. CONCLUSION In patients receiving intensive care after cardiothoracic surgery, GIisch cannot be ruled out based solely on CTA findings. A scoring system combining CTA findings with other variables may improve the diagnosis of GIisch in this population.
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Affiliation(s)
- Francois Stephan
- Paris Saclay University, School of Medicine, Le Kremlin Bicetre, France
| | - Mathilde Facque
- Intensive Care Unit, Hopital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Fares Ben Salem
- Department of Radiology, Hopital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Olivia Picq
- Intensive Care Unit, Hopital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Audrey Imbert
- Intensive Care Unit, Hopital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Thibaut Genty
- Intensive Care Unit, Hopital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Marc Zins
- Department of Radiology, Hopital Marie-Lannelongue, Le Plessis-Robinson, France
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Luo X, Wang J, Tan C, Dou Q, Han Z, Wang Z, Tasnim F, Wang X, Zhan Q, Li X, Zhou Q, Cheng J, Liao F, Yip HC, Jiang J, Tan RT, Liu S, Yu H. Rapid Endoscopic Diagnosis of Benign Ulcerative Colorectal Diseases With an Artificial Intelligence Contextual Framework. Gastroenterology 2024:S0016-5085(24)00365-2. [PMID: 38583724 DOI: 10.1053/j.gastro.2024.03.039] [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: 05/24/2023] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND & AIMS Benign ulcerative colorectal diseases (UCDs) such as ulcerative colitis, Crohn's disease, ischemic colitis, and intestinal tuberculosis share similar phenotypes with different etiologies and treatment strategies. To accurately diagnose closely related diseases like UCDs, we hypothesize that contextual learning is critical in enhancing the ability of the artificial intelligence models to differentiate the subtle differences in lesions amidst the vastly divergent spatial contexts. METHODS White-light colonoscopy datasets of patients with confirmed UCDs and healthy controls were retrospectively collected. We developed a Multiclass Contextual Classification (MCC) model that can differentiate among the mentioned UCDs and healthy controls by incorporating the tissue object contexts surrounding the individual lesion region in a scene and spatial information from other endoscopic frames (video-level) into a unified framework. Internal and external datasets were used to validate the model's performance. RESULTS Training datasets included 762 patients, and the internal and external testing cohorts included 257 patients and 293 patients, respectively. Our MCC model provided a rapid reference diagnosis on internal test sets with a high averaged area under the receiver operating characteristic curve (image-level: 0.950 and video-level: 0.973) and balanced accuracy (image-level: 76.1% and video-level: 80.8%), which was superior to junior endoscopists (accuracy: 71.8%, P < .0001) and similar to experts (accuracy: 79.7%, P = .732). The MCC model achieved an area under the receiver operating characteristic curve of 0.988 and balanced accuracy of 85.8% using external testing datasets. CONCLUSIONS These results enable this model to fit in the routine endoscopic workflow, and the contextual framework to be adopted for diagnosing other closely related diseases.
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Affiliation(s)
- Xiaobei Luo
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Department of Gastroenterology, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, Guangdong, China.
| | - Jiahao Wang
- Mechanobiology Institute, National University of Singapore, Singapore; Institute of Bioengineering and Bioimaging, Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Chuanchuan Tan
- The First Hospital of Hunan University of Chinese Medicine, Hunan, China
| | - Qi Dou
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Zelong Han
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhenjiang Wang
- Department of Gastroenterology, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, Guangdong, China
| | - Farah Tasnim
- Institute of Bioengineering and Bioimaging, Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Xiyu Wang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qiang Zhan
- Department of Gastroenterology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xiang Li
- Digestive Department of The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, China
| | - Qunyan Zhou
- Department of Gastroenterology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, Jiangsu, China
| | - Jianbin Cheng
- Department of Gastroenterology, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, Guangdong, China
| | - Fabiao Liao
- Digestive Department of The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, China
| | - Hon Chi Yip
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Jiayi Jiang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Robby T Tan
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore
| | - Side Liu
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Department of Gastroenterology, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, Guangdong, China.
| | - Hanry Yu
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Mechanobiology Institute, National University of Singapore, Singapore; Institute of Bioengineering and Bioimaging, Agency for Science, Technology and Research (A∗STAR), Singapore; CAMP, Singapore-MIT Alliance for Research and Technology, Singapore; Department of Physiology, The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, Singapore.
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Jayapadman V, Amer M, Ding J, Behrenbruch C. Subacute ischaemic colitis at Sudek's point requiring Hartmann's operation. ANZ J Surg 2024; 94:476-477. [PMID: 37953535 DOI: 10.1111/ans.18778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Vivek Jayapadman
- Colorectal Surgery Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Mohammad Amer
- Colorectal Surgery Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - John Ding
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Corina Behrenbruch
- Colorectal Surgery Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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7
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Wang CL, Si ZK, Liu GH, Chen C, Zhao H, Li L. Ischemic colitis induced by a platelet-raising capsule: A case report. World J Clin Cases 2024; 12:607-615. [PMID: 38322454 PMCID: PMC10841939 DOI: 10.12998/wjcc.v12.i3.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/09/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Ischemic colitis (IC) is also known as colon ischemia and is caused by colon vascular occlusion or nonocclusion, which results in a reduced blood supply to the colon and is not significant enough to maintain the metabolic function of cells, leading to intestinal wall ischemia. Its main symptoms include abdominal pain, diarrhea, and bloody stool. In severe cases, intestinal gangrene, peritonitis, intestinal stenosis and even intestinal obstruction may occur. IC induced by long-term use of certain special drugs is relatively rare in clinical practice. This article describes the clinical diagnosis and treatment of a typical case and provides a new treatment idea for the treatment of IC. CASE SUMMARY The patient was admitted to the hospital with "abdominal pain for half a month and bloody stool with mucous and pus for 3 d" and was diagnosed with "IC". Symptomatic and supportive treatment, such as antibiotics (levofloxacin), acid inhibition and stomach protection, fluid replenishment, and intravenous nutrition, was given. The patient's colonic ulcers were considered to be related to the oral administration of platelet (PLT)-raising capsules; the patient was asked to stop PLT-raising drugs for selective review via colonoscopy, and antibiotics and mesalazine enteric-coated tablets were stopped. Under the guidance of hematology consultation, 60 mg of methylprednisolone was given in combination with PLT infusion to increase the PLT. After treatment, the patient's condition stabilized, the patient's stool turned yellow, the patient's symptoms improved, and the patient was allowed to leave the hospital. CONCLUSION PLT-raising capsules can lead to IC, so clinicians should have a full understanding of the application of these drugs in the treatment of various causes of thrombocytopenia, weigh the advantages and disadvantages, and observe patients closely.
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Affiliation(s)
- Chen-Lu Wang
- The Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang 261000, Shandong Province, China
| | - Ze-Kun Si
- The Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang 261000, Shandong Province, China
| | - Guo-Hong Liu
- Department of Gastroenterology, The Affiliated Hospital of Shandong Second Medical University, Weifang 261000, Shandong Province, China
| | - Chen Chen
- Department of Gastroenterology, The Affiliated Hospital of Shandong Second Medical University, Weifang 261000, Shandong Province, China
| | - Hui Zhao
- Department of Gastroenterology, The Affiliated Hospital of Shandong Second Medical University, Weifang 261000, Shandong Province, China
| | - Lei Li
- The Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang 261000, Shandong Province, China
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8
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Lee GW, Park SB. Congestive ischemic colitis successfully treated with anti-inflammatory therapy: A case report. World J Clin Cases 2024; 12:142-147. [PMID: 38292639 PMCID: PMC10824190 DOI: 10.12998/wjcc.v12.i1.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/03/2023] [Accepted: 12/14/2023] [Indexed: 01/02/2024] Open
Abstract
BACKGROUND Congestive ischemic colitis is a rare subtype of ischemic colitis with an unknown pathophysiology. Excluding conservative management, such as fasting, no established treatment exists; therefore, surgical intervention should be considered in some cases if symptoms worsen. Current literature suggests that anti-inflammatory agents may effectively treat congestive ischemic colitis. CASE SUMMARY We present the case of a 68-year-old female patient who underwent laparoscopic left hemicolectomy for transverse colon cancer 3 years ago. Postoperatively, follow-up included an annual colonoscopy and abdominal computed tomography (CT) at a local clinic. However, progressive erythema and edema of the sigmoid colon were observed 1 year postoperatively. Upon admission to our hospital, she complained of abdominal pain and diarrhea. Abdominal CT showed thickening of the sigmoid colon walls, and colonoscopy revealed erythema, edema, and multiple ulcers with exudate in the sigmoid colon. CT angiography showed engorgement of the sigmoid vasa recta without any vascular abnormalities. The diagnosis was congestive ischemic colitis, and we treated the patient with anti-inflammatory agents. After 2 mo of glucocorticoid therapy (20 mg once daily) and 7 mo of 5-aminosalicylate therapy (1 g twice daily), the ulcers completely healed. She has not experienced any recurrence for 2 years. CONCLUSION Anti-inflammatory therapy, specifically glucocorticoids and 5-aminosalicylate, has demonstrated promising efficacy and introduces potential novel treatment options for congestive ischemic colitis.
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Affiliation(s)
- Geon Woo Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Su Bum Park
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
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He F, Yang F, Chen D, Tang C, Woraikat S, Xiong J, Qian K. Risk factors for anastomotic stenosis after radical resection of rectal cancer: A systematic review and meta-analysis. Asian J Surg 2024; 47:25-34. [PMID: 37704476 DOI: 10.1016/j.asjsur.2023.08.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/09/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
Radical resection of rectal cancer is a safe and effective treatment, but there remain several complications related to anastomosis. We aimed to assess the risk factors and incidence of rectal anastomotic stenosis (AS) after rectal cancer resection. We conducted a systematic review and meta-analysis after searching PubMed, Embase, Web of Science, and Medline databases from inception until May 2023. Data are reported as the combined odds ratio (OR) for categorical variables and the weighted mean difference (WMD) for continuous variables. Six hundred and fifty-nine studies were retrieved, nine (3031 patients) of which were included in the meta-analysis. Young age (WMD = -3.09, P = 0.0002), male sex (OR = 1.53, P = 0.0002), smoking (OR = 1.54, P = 0.009), radiotherapy (OR = 2.34, P = 0.0002), protective stoma (OR = 2.88, P = 0.007), intersphincteric resection surgery (OR = 6.28, P = 0.05), anastomotic fistula (OR = 3.72, P = 0.003), and anastomotic distance (WMD = -3.11, P = 0.0006) were identified as factors that increased the risk of AS, while staple (OR = 0.39, P < 0.001) was a protective factor. The incidence of AS after rectal cancer resection was approximately 17% (95% CI: 13%-21%). We identified eight risk factors and one protective factor associated with AS after rectal cancer resection. These factors may be combined in future studies to develop a more comprehensive and accurate prediction model related to AS after rectal cancer resection.
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Affiliation(s)
- Fan He
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fuyu Yang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Defei Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Chenglin Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Saed Woraikat
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Junjie Xiong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Kun Qian
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Novotny T, Staffa R, Tomandl J, Krivka T, Kruzliak P, Tomandlova M, Slaby O, Sponiar J, Caprnda M, Gaspar L, Rodrigo L, Mozos I, Kubicek L, Biros E, Vlachovsky R, Radova L, Konieczna A. Procalcitonin kinetics following abdominal aortic surgery and its value for postoperative intestinal ischaemia detection. Vascular 2023; 31:1061-1068. [PMID: 35594244 DOI: 10.1177/17085381221102812] [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: 11/17/2022]
Abstract
OBJECTIVE The purpose of our study was to describe perioperative kinetics of procalcitonin (PCT) in patients undergoing aortic surgery, to compare the kinetics in the open abdominal aortic aneurysm (AAA) repair and aortobifemoral bypass for aortoiliac occlusive disease (AIOD), and to evaluate the ability of PCT to detect intestinal ischaemia. METHODS A prospective non-randomized observational cohort study in 80 patients (62 men and 18 women) undergoing elective aortic surgery was performed. Serum PCT was measured at baseline and defined intraoperative and postoperative timepoints up to postoperative day 7. MRI contrast-enhanced imaging was used to detect intestinal ischaemia. RESULTS The comparison of the AAA and AIOD cohort did not show any significant difference in PCT levels. Patients with intestinal ischaemia had higher serum PCT at multiple timepoints postoperatively. The most accurate timepoints for early diagnosis were postoperative day 3, followed by 24 h after declamping of the vascular reconstruction, and postoperative day 7. The sensitivity and negative predictive values were 100% in all mentioned timepoints. However, event at the best timepoint the specificity was 89% and the positive predictive value 43%. CONCLUSIONS Procalcitonin levels in the postoperative period at proper timepoints might help to detect postoperative intestinal ischaemia. The limitation of this marker is its low specificity for intestinal ischaemia and low positive predictive value. The highest value of this marker is that it can rule out this complication because normal PCT levels mean that intestinal ischaemia is very unlikely.
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Affiliation(s)
- Tomas Novotny
- 2nd Department of Surgery, St. Anne's University Hospital Brno, Czech Republic
- 2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Robert Staffa
- 2nd Department of Surgery, St. Anne's University Hospital Brno, Czech Republic
- 2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Josef Tomandl
- Department of Biochemistry, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Krivka
- Department of Medical Imaging, St. Anne's University Hospital Brno, Czech Republic
- Department of Medical Imaging, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Peter Kruzliak
- 2nd Department of Surgery, St. Anne's University Hospital Brno, Czech Republic
- 2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marie Tomandlova
- Department of Biochemistry, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ondrej Slaby
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Sponiar
- 2nd Department of Surgery, St. Anne's University Hospital Brno, Czech Republic
- 2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Caprnda
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovakia
| | - Ludovit Gaspar
- Faculty of Health Sciences, University of Ss. Cyril and Methodius in Trnava, Trnava, Slovakia
| | - Luis Rodrigo
- Faculty of Medicine, University of Oviedo and Central University Hospital of Asturias (HUCA), Oviedo, Spain
| | - Ioana Mozos
- Department of Functional Sciences, Discipline of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
- Center for Translational Research and Systems Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Lubos Kubicek
- 2nd Department of Surgery, St. Anne's University Hospital Brno, Czech Republic
- 2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ernest Biros
- 2nd Department of Surgery, St. Anne's University Hospital Brno, Czech Republic
- 2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Robert Vlachovsky
- 2nd Department of Surgery, St. Anne's University Hospital Brno, Czech Republic
- 2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lenka Radova
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Anna Konieczna
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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11
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Garzelli L, Ben Abdallah I, Nuzzo A, Zappa M, Corcos O, Dioguardi Burgio M, Cazals-Hatem D, Rautou PE, Vilgrain V, Calame P, Ronot M. Insights into acute mesenteric ischaemia: an up-to-date, evidence-based review from a mesenteric stroke centre unit. Br J Radiol 2023; 96:20230232. [PMID: 37493183 PMCID: PMC10607400 DOI: 10.1259/bjr.20230232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 07/27/2023] Open
Abstract
Radiologists play a central role in the diagnostic and prognostic evaluation of patients with acute mesenteric ischaemia (AMI). Unfortunately, more than half of AMI patients undergo imaging with no prior suspicion of AMI, making identifying this disease even more difficult. A confirmed diagnosis of AMI is ideally made with dynamic contrast-enhanced CT but the diagnosis may be made on portal-venous phase images in appropriate clinical settings. AMI is diagnosed on CT based on the identification of vascular impairment and bowel ischaemic injury with no other cause. Moreover, radiologists must evaluate the probability of bowel necrosis, which will influence the treatment options.AMI is usually separated into different entities: arterial, venous, non-occlusive and ischaemic colitis. Arterial AMI can be occlusive or stenotic, the dominant causes being atherothrombosis, embolism and isolated superior mesenteric artery (SMA) dissection. The main finding in the bowel is decreased wall enhancement, and necrosis can be suspected when dilatation >25 mm is identified. Venous AMI is related to superior mesenteric vein (SMV) thrombosis as a result of a thrombophilic state (acquired or inherited), local injury (cancer, inflammation or trauma) or underlying SMV insufficiency. The dominant features in the bowel are hypoattenuating wall thickening with submucosal oedema. Decreased enhancement of the involved bowel suggests necrosis. Non-occlusive mesenteric ischaemia (NOMI) is related to impaired SMA flow following global hypoperfusion associated with low-flow states. There are numerous findings in the bowel characterised by diffuse extension. An absence of bowel enhancement and a thin bowel wall suggest necrosis in NOMI. Finally, ischaemic colitis is a sub-entity of arterial AMI and reflects localised colon ischaemia-reperfusion injury. The main CT finding is a thickened colon wall with fat stranding, which seems to be unrelated to SMA or inferior mesenteric artery lesions. A precise identification and description of vascular lesions, bowel involvement and features associated with transmural necrosis is needed to determine patient treatment and outcome.
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Affiliation(s)
| | - Iannis Ben Abdallah
- Université Paris Cité, France & Service de chirurgie vasculaire, Hôpital Bichat, APHP.Nord, Paris, France
| | - Alexandre Nuzzo
- Intestinal Stroke Center, Service de gastroenterologie, MICI et Insuffisance intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Magaly Zappa
- Université des Antilles & Service de radiologie, Centre Hospitalier André Rosemon, Cayenne, France
| | - Olivier Corcos
- Intestinal Stroke Center, Service de gastroenterologie, MICI et Insuffisance intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Marco Dioguardi Burgio
- Université Paris Cité, France & Service de radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Dominique Cazals-Hatem
- Université Paris Cité, France & Service d’anatomopathologie, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Pierre-Emmanuel Rautou
- Université Paris Cité, France & Service d’hépatologie, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Valérie Vilgrain
- Université Paris Cité, France & Service de radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Paul Calame
- Université Bourgogne Franche-comté, Service de radiologie, CHU Besançon, France
| | - Maxime Ronot
- Université Paris Cité, France & Service de radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France
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12
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Cong J, Zhang H, Chen C. Definition and grading of anastomotic stricture/stenosis following low anastomosis after total mesorectal excision: A single-center study. Asian J Surg 2023; 46:3722-3726. [PMID: 36967350 DOI: 10.1016/j.asjsur.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/31/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Anastomotic stricture/stenosis (AS) is an alarming complication after colorectal surgery, and there is still no recognized definition for AS. This study aimed to determine the status and change of AS after rectal surgery using a special AS definition and grading system, discuss various risk factors for AS. METHODS This study included patients with rectal cancer who underwent total mesorectal excision between May 2014 and May 2021. A five-degree special AS definition and grading system was used to determine AS status, and clinical outcomes and risk factors for AS were investigated. RESULTS A total of 473 patients were enrolled in this study. Univariate and multivariate analyses of patient-related and technical risk factors for AS were performed 3 months postoperatively. For univariate analysis, female sex was a lower risk factor for AS. Defunctioning stoma, neoadjuvant chemoradiotherapy, chemotherapy, and anastomotic leakage were higher risk factors for AS (all p < 0.05). For multivariate analysis, only neoadjuvant chemoradiotherapy, chemotherapy, and anastomotic leakage were still higher risk factors for AS (all p < 0.05). CONCLUSIONS Through a special AS definition and grading system's evaluation, we noted that neoadjuvant chemoradiotherapy, chemotherapy, and anastomotic leakage were the higher risk factors for AS.
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Affiliation(s)
- Jinchun Cong
- Ward of Colorectal Tumor, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Hong Zhang
- Ward of Colorectal Tumor, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Chunsheng Chen
- Ward of Colorectal Tumor, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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13
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Takatsu T, Misawa N, Yoshihara T, Ashikari K, Kessoku T, Ohkubo H, Hosono K, Yoneda M, Saito S, Nakajima A, Higurashi T. Prior appendectomy and cerebral infarction as potential risk factors for recurrent ischemic colitis: A retrospective observational study. JGH Open 2023; 7:559-566. [PMID: 37649858 PMCID: PMC10463018 DOI: 10.1002/jgh3.12948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 09/01/2023]
Abstract
Background and Aim Ischemic colitis (IC) is a benign disease associated with acute lower gastrointestinal bleeding and frequent recurrence. While several studies have investigated risk factors for IC onset, few have assessed the risk factors for recurrent IC. This study aimed to identify risk factors for recurrent IC. Methods Potential risk factors for recurrence were assessed by examining medical records and laboratory findings in this single-center retrospective study. We extracted the following data from the patients' medical records: patient characteristics, clinical signs and symptoms, laboratory findings, method of treatment, length of hospital stay, disease course, and the frequency of IC morbidities. Patients with IC were selected from a total of 439 312 patients over an 11-year period. Patients were divided into recurrent and nonrecurrent IC groups. Results In total, 225 patients met the diagnostic criteria for IC during the specified study period; of these, 204 patients (90.7%) and 21 patients (9.3%) were included in the nonrecurrent and recurrent IC groups, respectively. Univariate and multivariate analyses showed a significant association between IC recurrence and both cerebral infarction (P = 0.008, odds ratio [OR] = 6.3) and history of appendectomy (P = 0.0005, OR = 6.2). The median (interquartile range [IQR]) follow-up time for all patients was 1556 (353-2768) days; this was much longer than the median (IQR) time to recurrence of 291 (64-907) days in the recurrent IC group. Conclusion The results of this study suggest that prior cerebral infarction and appendicectomy may be risk factors for IC recurrence.
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Affiliation(s)
- Tomohiro Takatsu
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
- Department of GastroenterologySanno HospitalTokyoJapan
| | - Noboru Misawa
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Tsutomu Yoshihara
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Keiichi Ashikari
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Takaomi Kessoku
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Hidenori Ohkubo
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Kunihiro Hosono
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Masato Yoneda
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Satoru Saito
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Atsushi Nakajima
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Takuma Higurashi
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
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14
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Saeed S, Ekhator C, Abdelaziz AM, Naveed H, Karski A, Cook DE, Reddy SM, Affaf M, Khan SJ, Bellegarde SB, Rehman A, Hasan AH, Shehryar A. Revolutionizing Inflammatory Bowel Disease Management: A Comprehensive Narrative Review of Innovative Dietary Strategies and Future Directions. Cureus 2023; 15:e44304. [PMID: 37664362 PMCID: PMC10470660 DOI: 10.7759/cureus.44304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/05/2023] Open
Abstract
This comprehensive narrative review delves into the intricate interplay between diet and inflammatory bowel disease (IBD), shedding light on the potential impact of dietary interventions in disease management. By analyzing nutritional interventions, risks, challenges, and future perspectives, this review serves as a vital resource for clinicians, researchers, and patients alike. The amalgamation of evidence underscores the significance of customizing dietary strategies for individual patients, considering disease phenotype and cultural factors. Through an exploration of dietary components' effects on IBD, including exclusive enteral nutrition and omega-3 fatty acids, this review offers pragmatic implementation advice and outlines avenues for further research. Bridging the gap between research findings and clinical applications, the review facilitates informed decision-making and patient-centric care. In the face of escalating IBD prevalence, this review emerges as an indispensable guide for healthcare professionals, empowering them to navigate the complexities of dietary management while enabling patients to actively participate in their care trajectory. Ultimately, this narrative review advances the understanding of diet's pivotal role in IBD management, fostering a more integrated approach to patient care and paving the way for improved research and policy initiatives in the field of inflammatory bowel diseases.
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Affiliation(s)
- Shahzeb Saeed
- Internal Medicine, Army Medical College, Rawalpindi, PAK
| | - Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, USA
| | - Ali M Abdelaziz
- Internal Medicine, Alexandria University Faculty of Medicine, Alexandria, EGY
| | - Husnain Naveed
- Internal Medicine, Shifa Tameer-E-Millat University Shifa College of Medicine, Islamabad, PAK
| | - Amanda Karski
- Emergency Medicine, American University of Antigua, Miami, USA
| | - Daniel E Cook
- Medicine, Avalon University School of Medicine, Youngstown, USA
| | - Shivani M Reddy
- Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, IND
| | - Maryam Affaf
- Internal Medicine, Women's Medical and Dental College, Abbotabad, PAK
| | - Salman J Khan
- Hematology & Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Sophia B Bellegarde
- Pathology and Laboratory Medicine, American University of Antigua, St. John's, ATG
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15
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Kent I, Ghuman A, Sadran L, Rov A, Lifschitz G, Rudnicki Y, White I, Goldberg N, Avital S. Emergency Colectomies in the Elderly Population—Perioperative Mortality Risk-Factors and Long-Term Outcomes. J Clin Med 2023; 12:jcm12072465. [PMID: 37048549 PMCID: PMC10095288 DOI: 10.3390/jcm12072465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 03/28/2023] Open
Abstract
Background: As the population ages emergency surgeries among the elderly population, including colonic resections, is also increasing. Data regarding the short- and long-term outcomes in this population is scarce. Methods: A retrospective study was performed to investigate mortality and mortality risk factors associated with emergent colectomies in older compared to younger patients in a single university affiliated tertiary hospital. Patients with metastatic disease, colectomy due to trauma or index colectomy within 30 days prior to emergent surgery were excluded. Results: Operative outcomes compared among age groups, included 30-day mortality, mortality risk-factors and long-term survival. 613 eligible patients were included in the cohort. Mean age was 69.4 years, 45.1% were female. Patients were divided into four age groups: 18–59, 60–69, 70–79 and ≥80-years. Thirty-day mortality rates were 3.2%, 11%, 29.3% and 37.8%, respectively and 22% for the entire cohort. Risk-factors for perioperative death in the younger group were related to severity of ASA score and WBC count. In groups 60–69, 70–79, main risk-factors were ADL dependency and ASA score. In the ≥80 group, risk-factors affecting perioperative mortality, included ASA score, pre-operative albumin, creatinine, WBC levels, cancer etiology, ADL dependency, and dementia. Long-term survival differed significantly between age groups. Conclusion: Perioperative mortality with emergency colectomy increases with patients’ age. Patients older than eighty-years undergoing urgent colectomies have extremely high mortality rates, leading to a huge burden on medical services. Evaluating risk-factors for mortality and pre-operative discussion with patients and families is important. Screening the elderly population for colonic pathologies can result in early diagnosis potentially leading to elective surgeries with decreased mortality.
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16
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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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17
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Maqboul I, Demyati K, Abdoh Q, Suleiman Q, Daraghmeh L. An arteriovenous malformation associated ischemic colitis in the setting of acute gastrointestinal clostridium difficile colitis and intestinal amebiasis: A case report. Int J Surg Case Rep 2023; 105:108063. [PMID: 37004449 PMCID: PMC10112014 DOI: 10.1016/j.ijscr.2023.108063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND There is one reported case of inferior mesenteric arteriovenous malformation presenting as ischemic colitis after an episode of gastrointestinal infection. We documented this case to emphasize the possible association between ischemic colitis and vascular malformations. In addition, this is the number 15th case in the literature about this association. CASE SUMMARY A 40 years old male patient presented with abdominal pain and diarrhea of 10 days duration after he was diagnosed and managed as a case of Clostridium Difficile infection and amebiasis. Computed tomography angiography revealed a vascular malformation of the inferior mesenteric artery, repeated colonoscopy showed ulceration and sloughing of the mucosa, he underwent Hartmann's procedure due to colonic ischemia diagnosed by the previous measures. Later on he had a colostomy closure and end to end colorectal anastomosis. CONCLUSION There is a possible association between acute gastrointestinal infection and ischemic colitis in the setting of arteriovenous malformation.
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Affiliation(s)
- Iyad Maqboul
- Department of Medicine Faculty of Medicine & Health Sciences, An-Najah National University Hospital, State of Palestine.
| | - Khaled Demyati
- An-Najah National University Hospital, State of Palestine.
| | - Qusay Abdoh
- An-Najah National University Hospital, State of Palestine.
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18
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Theodore BC, Foulkrod A, Fujikawa P, Patel K. Ischemic Colitis Secondary to Olanzapine and Clonidine Use in a Patient With a History of Laxative Abuse. Cureus 2023; 15:e36605. [PMID: 37155452 PMCID: PMC10122613 DOI: 10.7759/cureus.36605] [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: 03/23/2023] [Indexed: 05/10/2023] Open
Abstract
Ischemic colitis is the most common type of intestinal ischemia and is caused by an acute arterial occlusion, thrombosis, or hypoperfusion of the mesenteric vasculature. This case centers around a 39-year-old female with a past medical history significant for a 20-year history of stimulant laxative abuse, chronic constipation, bipolar disorder, and anxiety that presented with ischemic colitis following 21 days of obstipation. At the time of presentation, the patient was taking olanzapine 15 mg daily for the treatment of bipolar disorder and clonidine 0.2 mg three times daily for anxiety. Over the course of her hospitalization, the patient was found to have a high stool burden, including calcified stool, contributing to ischemic colitis. She was successfully treated with a clonidine taper, multiple enemas, and laxatives. Pharmacological agents that induce constipation have been shown to increase the risk of colonic ischemia by increasing intraluminal pressure in the colon. Atypical antipsychotics block peripheral anticholinergic and anti-serotonergic receptors, limit gastrointestinal muscle contractions, and delay intestinal transit.
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Affiliation(s)
| | - Ashley Foulkrod
- Internal Medicine, Edward Via College of Osteopathic Medicine (VCOM)-Virginia, Blacksburg, USA
| | | | - Kashyap Patel
- Internal Medicine, LewisGale Medical Center, Salem, USA
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19
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Alexander D, Abdelazeem B, Alnounou M. Olmesartan-Induced Ischemic Enteritis Complicated With Bowel Perforation: A Case Report and Literature Review. Cureus 2023; 15:e36660. [PMID: 37101993 PMCID: PMC10124147 DOI: 10.7759/cureus.36660] [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: 03/24/2023] [Indexed: 04/28/2023] Open
Abstract
Olmesartan is a relatively new angiotensin receptor blocker used widely to control hypertension. Cases have been reported previously of enteropathy induced by olmesartan. Here, the authors report a case of olmesartan-induced ischemic enteritis complicated by bowel perforation. A 52-year-old male patient, during the treatment with olmesartan, developed severe abdominal pain of five-day duration. He underwent exploratory laparotomy for bowel perforation and surgical resection of the ischemic bowel segment. On a two-month follow-up after the discontinuation of olmesartan and the emergency surgery, the patient was symptom-free and functioning well. This rare report focuses on ischemic enteritis associated with olmesartan, describes the symptoms, and records the progression of this side effect and the corresponding treatment. Our case aims to raise awareness amongst physicians about the possibility of this severe complication and to point out that more research is still needed on its pathophysiology to better understand this drug.
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Affiliation(s)
- Dheeraj Alexander
- Internal Medicine, McLaren Health Care, Flint/Michigan State University, Flint, USA
| | - Basel Abdelazeem
- Internal Medicine, McLaren Health Care, Flint/Michigan State University, Flint, USA
| | - Mustafa Alnounou
- Gastroenterology, McLaren Health Care, Flint/Michigan State University, Flint, USA
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20
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Imaging of Bowel Ischemia: An Update, From the AJR Special Series on Emergency Radiology. AJR Am J Roentgenol 2023; 220:173-185. [PMID: 35946859 DOI: 10.2214/ajr.22.28140] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Acute mesenteric ischemia is a life-threatening condition that results from abrupt reduction in or cessation of blood flow to the bowel. Characterized by nonspecific abdominal symptoms, mesenteric ischemia is infrequently encountered and commonly misdiagnosed, with potentially catastrophic consequences. Prompt clinical diagnosis and early implementation of therapeutic interventions are critical to improving patient outcomes. Because cross-sectional imaging plays a key role in the diagnosis of mesenteric ischemia, radiologists must be familiar with the varied imaging manifestations of intestinal ischemia. Thus, the objectives of this article are to review the various types and common causes of mesenteric ischemia and to describe its spectrum of multimodality imaging findings, with special attention to novel imaging techniques and emerging diagnoses.
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21
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Koshelev EG, Belyaev GY, Egorov AA. [Computed tomography diagnostics of acute and chronic mesenteric ischemia]. Khirurgiia (Mosk) 2023:67-82. [PMID: 38088843 DOI: 10.17116/hirurgia202312167] [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: 12/18/2023]
Abstract
BACKGRAUND Chronic mesenteric ischemia is more often accompanied by clinical signs characteristic of colitis. Acute mesenteric ischemia, unlike chronic, is accompanied by nonspecific symptoms and is a serious disease that requires urgent diagnosis. AIMS The aim of the study was to evaluate the effectiveness of MSCT in the diagnosis of acute and chronic mesenteric ischemia based on our observations. MATERIALS AND METHODS The retrospective study included 135 patients with abdominalgia and suspected mesenteric ischemia who underwent multiphase CT of the abdominal cavity with intravenous bolus contrast enhancement. Group 1 included 105 patients with mesenteric ischemia; group 2 included 30, without confirmed mesenteric ischemia, with the presence of a symptom of mesenteric ischemia in the form of abdominalgia. RESULTS We studied 135 patients, including 105 patients with mesenteric ischemia, 59 women and 46 men of average age 60±14.9 years. The acute form of ischemia (58%) was determined 1.5 times more often than the chronic one. Occlusive and nonocclusive acute mesenteric ischemia occurred in equal proportions. Mesenteric arterial thrombosis was the cause of acute mesenteric ischemia in 23% of cases. Mesenteric venous thrombosis was the cause of chronic intestinal ischemia in 61%, in 5% - acute form. Mixed arterial-venous genesis of mesenteric ischemia was determined in 4% against the background of strangulation obstruction. Dunbar syndrome as a cause of chronic intestinal ischemia was diagnosed in 16%. Chronic ischemic enterocolitis accounted for 10% of all cases of mesenteric ischemia and 23% of chronic ischemia. Symptoms and symptom complexes characteristic of the studied series of diseases with acute or chronic mesenteric ischemia were delineated. Sensitivity, specificity and prognostic value of CT with intravenous bolus contrast enhancement in diagnostics of diseases accompanied by mesenteric ischemia reached 100%. CONCLUSIONS Multiphase CT of the abdominal cavity with bolus contrast enhancement is highly informative in the diagnosis of acute and chronic forms of mesenteric ischemia. Direct CT signs of impaired blood flow in the arteries or veins of the mesentery were indisputable. Indirect signs of mesenteric ischemia were aimed at a thorough analysis of the condition of mesenteric vessels.
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Affiliation(s)
- E G Koshelev
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Clinical Hospital of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
| | - G Yu Belyaev
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Polyclinic No. 2 of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
| | - A A Egorov
- Polyclinic No. 2 of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
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22
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Garzelli L, Nuzzo A, Hamon A, Ben Abdallah I, Gregory J, Raynaud L, Paulatto L, Dioguardi Burgio M, Castier Y, Panis Y, Vilgrain V, Corcos O, Ronot M. Reperfusion injury on computed tomography following endovascular revascularization of acute mesenteric ischemia: prevalence, risk factors, and patient outcome. Insights Imaging 2022; 13:194. [PMID: 36512135 PMCID: PMC9748024 DOI: 10.1186/s13244-022-01339-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Data about reperfusion injury (RI) following acute arterial mesenteric ischemia (AAMI) in humans are scarce. We aimed to assess the prevalence and risk factors of RI following endovascular revascularization of AMI and evaluate its impact on patient outcomes. METHODS Patients with AAMI who underwent endovascular revascularization (2016-2021) were included in this retrospective cohort. CT performed < 7 days after treatment was reviewed to identify features of RI (bowel wall hypoattenuation, mucosal hyperenhancement). Clinical, laboratory, imaging, and treatments were compared between RI and non-RI patients to identify factors associated with RI. Resection rate and survival were also compared. RESULTS Fifty patients (23 men, median 72-yrs [IQR 60-77]) were included, and 22 were diagnosed with RI (44%) after a median 28 h (22-48). Bowel wall hypoattenuation and mucosal hyperenhancement were found in 95% and 91% of patients with post-interventional RI, respectively. Patients with RI had a greater increase of CRP levels after endovascular treatment (p = 0.01). On multivariate analysis, a decreased bowel wall enhancement on baseline CT (HR = 8.2), an embolic cause (HR = 7.4), complete SMA occlusion (HR = 7.0), and higher serum lactate levels (HR = 1.4) were associated with RI. The three-month survival rate was 78%, with no difference between subgroups (p = 0.99). However, the resection rate was higher in patients with RI (32% versus 7%; p = 0.03). CONCLUSION RI is frequent after endovascular revascularization of AAMI, especially in patients who present with decreased bowel wall enhancement on pre-treatment CT, an embolic cause, and a complete occlusion of the SMA. However, its occurrence does not seem to negatively impact short-term survival.
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Affiliation(s)
- Lorenzo Garzelli
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Alexandre Nuzzo
- grid.411599.10000 0000 8595 4540Intestinal Stroke Center, Service de Gastroenterology, MICI Et Insuffisance Intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Annick Hamon
- grid.411599.10000 0000 8595 4540Intestinal Stroke Center, Service de Gastroenterology, MICI Et Insuffisance Intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Iannis Ben Abdallah
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411119.d0000 0000 8588 831XService de Chirurgie Vasculaire, Hôpital Bichat, APHP.Nord, Paris, France
| | - Jules Gregory
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Lucas Raynaud
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Luisa Paulatto
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Marco Dioguardi Burgio
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Yves Castier
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411119.d0000 0000 8588 831XService de Chirurgie Vasculaire, Hôpital Bichat, APHP.Nord, Paris, France
| | - Yves Panis
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411119.d0000 0000 8588 831XService de Chirurgie Digestive, Hôpital Bichat, APHP.Nord, Paris, France
| | - Valérie Vilgrain
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Olivier Corcos
- grid.411599.10000 0000 8595 4540Intestinal Stroke Center, Service de Gastroenterology, MICI Et Insuffisance Intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Maxime Ronot
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
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Wongtrakul W, Charoenngam N, Ungprasert P. The association between irritable bowel syndrome and ischemic colitis: a systematic review and meta-analysis. Minerva Gastroenterol (Torino) 2022; 68:470-474. [PMID: 34547858 DOI: 10.23736/s2724-5985.21.02957-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Studies have suggested an association between ischemic colitis and irritable bowel syndrome (IBS) although the results were inconsistent. This systematic review and meta-analysis were performed to comprehensively examine the association between IBS and ischemic colitis by identifying all available cohort and case-control studies and combining their effect estimates together. EVIDENCE ACQUISITION EMBASE, MEDLINE and Google Scholar databases were systematically reviewed up to June 2020. Eligible study had to be either cohort or case-control studies that evaluated whether patients with IBS have a higher risk of ischemic colitis than individuals without IBS. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. EVIDENCE SYNTHESIS The systematic review identified three cohort and eight case-control studies. The pooled analysis found a significantly higher risk of ischemic colitis among patient with IBS with the pooled odds ratio of 2.50 (95% CI, 2.00-3.14; I2 57%). Funnel plot was relatively symmetric and was not suggestive of presence of publication bias. CONCLUSIONS A significantly increased risk of ischemic colitis among patients with IBS was observed in this systematic review and meta-analysis.
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Affiliation(s)
- Wasit Wongtrakul
- Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand -
| | - Nipith Charoenngam
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patompong Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
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Zhou S, Shi Q, Zheng Y, Zhuang Y, Lin Y, Huang Z, Yu J. Sheng-Xue-Xiao-Ban Capsule-induced ischemic colitis and pulmonary embolism in an idiopathic thrombocytopenic purpura patient: a rare case report. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1027. [PMID: 36267749 PMCID: PMC9577723 DOI: 10.21037/atm-22-3951] [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: 07/15/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Sheng-Xue-Xiao-Ban Capsule (SXXBC), as a classic Chinese traditional medicine comprised of natural indigo, cortex moutan, forsythia, herba agrimoniae, and licorice, exhibits a heat-clearing and detoxicating function, hemostasis, and stasis dissipation, which is widely applied to treat idiopathic thrombocytopenic purpura (ITP). However, report on ischemic colitis and pulmonary embolism induced by SXXBC therapy is never disclosed. We report the case of an ITP patient who received SXXBC for ascending platelets that then induced ischemic colitis and pulmonary embolism. CASE DESCRIPTION A 74-year-old female patient was admitted in June 2021 due to "bleeding in stool for 1 day," she was then re-admitted in July 2021 due to "repeated bleeding in stool for 2 days". Abdominal computed tomography (CT), colonoscopy, and a pathological examination suggested ischemic colitis according to the American College of Gastroenterology (ACG) clinical guidelines. Pulmonary artery CT angiography suggested pulmonary embolism reflected by multiple filling defects, and the patient presented with shortness of breath. It was noted that the patient had started taken SXXBC for ascending platelets 2 months before the onset of hematochezia. After the diagnosis of hematochezia was made, the patient received phenethylamine and carbazochrome for hemostasis, mesalazine enteric-coated tablets for anti-inflammation, and SXXBC was stopped. The hematochezia then ceased, and the ischemic colitis was attenuated. Afterwards, low-molecular-weight heparin was administered, followed by a 3-week treatment of rivaroxaban anticoagulant, which was taken orally after discharge. The pulmonary embolism was then obviously ameliorated. After excluding other causes, the patient was diagnosed with SXXBC-induced ischemic colitis complicated by pulmonary embolism. After conducting research, we came to the view that natural indigo, which is the main component of SXXBC, contributed to the patient's illness. CONCLUSIONS Ischemic colitis complicated with pulmonary embolism are rare; however, close attention such as regular abdominal CT test needs to be paid and preventive steps such as anti-coagulant treatment could to be taken (if symptoms occur) when treating patients with SXXBC.
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Affiliation(s)
- Sisi Zhou
- Department of Gastroenterology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Quan Shi
- Department of Gastroenterology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yanfeng Zheng
- Department of Gastroenterology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yihan Zhuang
- Department of Gastroenterology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yiting Lin
- Department of Gastroenterology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zeyu Huang
- Department of Gastroenterology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jing Yu
- Department of Gastroenterology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
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Huynh TM, Le QD, Bui KLN, Bui MQH, Vo CMH, Quach DT. Ischemic Colitis Presented as Pseudomembranous Colitis: An Untypical Case from Vietnam. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2022; 80:93-98. [PMID: 36004637 DOI: 10.4166/kjg.2022.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
Ischemic colitis (IC) is an underreported chronic disease characterized by the hypoperfusion of the bowel mucosa. The diagnosis and treatment may be challenging because its clinical course resembles other colitis or even colorectal malignancies. This paper reports an untypical case to underline the diversity of IC manifestation. A 68-year-old man with several comorbidities was admitted because of abdominal pain with a 6-month duration and a mass in the left lower quadrant. Colonoscopy revealed erosive pseudomembranous colitis narrowed colon segments with ulcerated mucosa mimicking colorectal cancer and inflammatory bowel disease. The stool cultures and Clostridium difficile toxin tests were negative. After the failure of conservative therapy, the Hartmann procedure with temporary ileostomy was performed uneventfully. The histological results of the surgical specimens revealed IC with focal pseudomembranous areas.
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Affiliation(s)
- Tien Manh Huynh
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Quang Dinh Le
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Gastroenterology, Gia-Dinh People's Hospital, Ho Chi Minh City, Vietnam
| | - Khanh Lan Nguyen Bui
- Department of Gastroenterology, Gia-Dinh People's Hospital, Ho Chi Minh City, Vietnam
| | - Minh Quang Huynh Bui
- Department of Pathology and Forensic Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Cong Minh Hong Vo
- Department of Gastroenterology, Gia-Dinh People's Hospital, Ho Chi Minh City, Vietnam
| | - Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Gastroenterology, Gia-Dinh People's Hospital, Ho Chi Minh City, Vietnam
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Clinical characteristics and long-term outcomes of hospitalised patients with ischemic colitis with different degrees of haematochezia: a retrospective study. Eur J Gastroenterol Hepatol 2022; 34:823-830. [PMID: 35506923 DOI: 10.1097/meg.0000000000002386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Based on the literature, haematochezia is associated with a benign clinical course of ischaemic colitis. However, most cases in the literature presented mild haematochezia associated with ischaemic colitis. Therefore, we aimed to investigate the impact of different degrees of haematochezia on the clinical outcomes of ischaemic colitis. METHODS Patients were divided into nonhaematochezia, mild-haematochezia, and severe-haematochezia cohorts stratified by the degree of haematochezia. The clinical characteristics and prognoses were retrospectively reviewed. RESULTS Haematochezia cohort (n = 89) was associated with a lower rate of severe illness (25% vs. 52%, P = 0.001), lower rate of isolated right colon ischaemia (7% vs. 28%, P = 0.001), lower surgery rates (13% vs. 36%, P = 0.001), and shorter hospital stay (12 vs. 17 days, P < 0.001) compared with nonhaematochezia cohort (n = 50). Severe-haematochezia cohort (n = 11) had a higher frequency of severe illness (73% vs. 18%, P < 0.001), higher surgical intervention rate (55% vs. 6%, P < 0.001), higher nonsurgical complication rate, higher in-hospital mortality (45% vs. 0%, P < 0.001), and longer hospital stay (28 vs. 10 days, P = 0.001), compared with mild-haematochezia cohort (n = 78). Additionally, in-hospital mortality (45% vs. 6%, P = 0.003) and nonsurgical complication rate were higher in the severe-haematochezia than in the nonhaematochezia cohort. However, the three cohorts had comparable prognoses for long-term survival and recurrence. CONCLUSIONS Mild haematochezia was related to a benign clinical course of ischaemic colitis, while lack of haematochezia or severe haematochezia was associated with worse hospitalisation outcomes.
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Khazaaleh S, Gonzalez AJ, Alomari M, Wadhwa V, Shah B, Shen B. Ischemic Colitis Is a Risk Factor for Clostridium difficile Infection. Cureus 2022; 14:e26076. [PMID: 35875313 PMCID: PMC9295079 DOI: 10.7759/cureus.26076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: Clostridium difficile infection (CDI) is an anaerobic infection that can carry detrimental outcomes for patients and is a growing burden to the US healthcare system. Various theories have been proposed for the etiopathogenesis of CDI, including antibiotic use, dysbiosis, and acid suppression. The role of ischemia in CDI has not been explored. We hypothesize that tissue ischemia is a risk factor for the development of CDI. The study aimed to assess whether ischemia was a risk factor for CDI using ischemic colitis as a target population. Methods: We performed a case-control study using the National Inpatient Sample (NIS) database in 2013. The study group included all patients with ischemic colitis (ICD 9 Code: 557.0, 557.1, 557.9) and the control group included all patients with diverticulitis (ICD 9 Code: 562.11, 562.13). Univariable and multivariable analyses were performed to assess the risk factors associated with CDI (ICD 9 Code: 008.45). The case and control groups were compared using the chi-square test for analysis. Continuous variables were compared using t-tests and categorical variables were compared using Rao-Scott chi-square tests. In addition, multivariable logistic regression analysis was performed to assess the association between disease group and CDI while adjusting for confounders. Univariable analysis was performed to assess differences between subjects with ischemic colitis and those with diverticulitis; continuous variables were compared using t-tests and categorical variables were compared using Rao-Scott chi-square tests. All analyses were done using SAS (version 9.4, The SAS Institute, Cary, NC). Results: We analyzed more than 30 million hospitalizations in 2013, with 120,490 being Ischemic colitis-related admissions and 309,940 being diverticulitis-related admissions. The rate of CDI was more in the ischemic colitis group than in the diverticulitis group (odds ratio [OR] = 1.39; 95% confidence interval [CI] [1.03-1.88], p=0.03). After adjusting for all variables, multivariate analysis showed CDI was associated with ischemic colitis (OR = 2.06; 95% CI 1.59-2.65, p<0.001). Conclusion: CDI was shown to be more prevalent in ischemic colitis than in diverticulitis control in this population-based study. As C. difficile is an anaerobe, we hypothesize that tissue hypoxia is a risk factor for its development. Further studies are needed to validate our findings.
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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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Clinical features and risk factors for ischemic colitis in young and middle-aged patients. Acta Gastroenterol Belg 2022; 85:283-290. [DOI: 10.51821/85.2.9527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background and study aims: Ischemic colitis (IC) is thought to occur more frequently in the elderly, but the incidence in young and middle-aged adults is increasing. This study determined the clinical characteristics of and risk factors for young and middle- aged IC patients.
Patients and methods: The medical records of 190 IC patients from 2010-2020 were reviewed. The clinical features of the young and middle-aged IC group (group A, < 60 years [n=70]) were compared to the elderly IC (group B, ≥60 years [n=120]) and age- and gender-matched colon polyp groups (group C, <60 years [n=272]). Independent risk factors for IC in group A were assessed using multivariate logistic regression analysis.
Results: There were no significant differences in groups A and B with respect to season of onset, symptoms, signs, treatment, or recurrences. The main symptoms of group A were abdominal pain (98.6%) and hematochezia (98.6%). Lesions commonly involved the left half of the colon (87.1%) and the clinical conditions were generally not severe. The percentage of patients with constipation (11.4% vs. 4.0%, P=0.034) and using a calcium channel antagonist (21.4% vs. 11.4%, P=0.028) was significantly higher in group A than group C. Regression analysis demonstrated that constipation (OR 2.831, P=0.037) and taking a calcium channel antagonist (OR 2.486, P=0.012) were closely associated with the occurrence of IC in group A.
Conclusions: Constipation and taking a calcium channel antagonist were independent risk factors for the onset of IC in young and middle-aged adults. Among young and middle-aged adults with abdominal pain and bloody stools who also have constipation or are taking a calcium channel antagonist to treat hypertension, the diagnosis of IC should be considered.
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Silva Mendes S, Caetano AC, Arroja B. An Unpredictable Cause of Gastrointestinal Bleeding. Gastroenterology 2022; 162:e6-e8. [PMID: 34757140 DOI: 10.1053/j.gastro.2021.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Sofia Silva Mendes
- Gastroenterology Department, Braga Hospital, Braga, Portugal; Life and Health Sciences Research Institute ICVS, School of Medicine, University of Minho, Braga, Portugal.
| | - Ana Célia Caetano
- Gastroenterology Department, Braga Hospital, Braga, Portugal; Life and Health Sciences Research Institute ICVS, School of Medicine, University of Minho, Braga, Portugal
| | - Bruno Arroja
- Gastroenterology Department, Braga Hospital, Braga, Portugal
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31
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Pinto A, Lanzetta MM, Addeo G, Bonini MC, Grazzini G, Miele V. Errors in MDCT diagnosis of acute mesenteric ischemia. Abdom Radiol (NY) 2022; 47:1699-1713. [PMID: 32918107 DOI: 10.1007/s00261-020-02732-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/17/2020] [Accepted: 08/30/2020] [Indexed: 01/17/2023]
Abstract
The causes of diagnostic errors during daily medical practice can be several, mainly attributable to perceptual, interpretive and communication factors. The eventuality of radiological error is much more amplified in the emergency setting where a high number of complex multidetector-row computed tomography (MDCT) images must be evaluated quickly and critical time decisions need to be taken. In particular, in this context, the diagnosis of vascular intestinal diseases represents a crucial and difficult challenge in case of acute abdominal pain given the importance of being able to identify patient with high suspicious for intestinal ischemia and for a specific patient to judge if his ischemia is reversible or irreversible. Awareness of potential biases which can lead to diagnostic errors together with an extensive knowledge of the imaging features of these pathologies can lead to promptly recognize them with fewer mistakes, improving patients' outcome. This article reviews the MDCT findings of acute intestinal ischemia and acute colonic ischemia and analyzes the main types of diagnostic errors, underlining the importance of being familiarized with them to avoid misdiagnosis.
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Affiliation(s)
- Antonio Pinto
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Monica Marina Lanzetta
- Department of Emergency Radiology, Azienda Ospedaliero Universitaria Careggi, L.go G.A. Brambilla, 3, 50134, Florence, Italy
| | - Gloria Addeo
- Department of Emergency Radiology, Azienda Ospedaliero Universitaria Careggi, L.go G.A. Brambilla, 3, 50134, Florence, Italy.
| | - Maria Cristina Bonini
- Department of Emergency Radiology, Azienda Ospedaliero Universitaria Careggi, L.go G.A. Brambilla, 3, 50134, Florence, Italy
| | - Giulia Grazzini
- Department of Emergency Radiology, Azienda Ospedaliero Universitaria Careggi, L.go G.A. Brambilla, 3, 50134, Florence, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Azienda Ospedaliero Universitaria Careggi, L.go G.A. Brambilla, 3, 50134, Florence, Italy
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Dual-energy CT of acute bowel ischemia. Abdom Radiol (NY) 2022; 47:1660-1683. [PMID: 34191075 DOI: 10.1007/s00261-021-03188-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/17/2022]
Abstract
Acute bowel ischemia is a condition with high mortality and requires rapid intervention to avoid catastrophic outcomes. Swift and accurate imaging diagnosis is essential because clinical findings are commonly nonspecific. Conventional contrast enhanced CT of the abdomen has been the imaging modality of choice to evaluate suspected acute bowel ischemia. However, subtlety of image findings and lack of non-contrast or arterial phase images can make correct diagnosis challenging. Dual-energy CT provides valuable information toward assessing bowel ischemia. Dual-energy CT exploits the differential X-ray attenuation at two different photon energy levels to characterize the composition of tissues and reveal the presence or absence of faint intravenous iodinated contrast to improve reader confidence in detecting subtle bowel wall enhancement. With the same underlying technique, virtual non-contrast images can help to show non-enhancing hyperdense hemorrhage of the bowel wall in intravenous contrast-enhanced scans without the need to acquire actual non-contrast scans. Dual-energy CT derived low photon energy (keV) virtual monoenergetic images emphasize iodine contrast and provide CT angiography-like images from portal venous phase scans to better evaluate abdominal arterial patency. In Summary, dual-energy CT aids diagnosing acute bowel ischemia in multiple ways, including improving visualization of the bowel wall and mesenteric vasculature, revealing intramural hemorrhage in contrast enhanced scans, or possibly reducing intravenous contrast dose.
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Ksouri A, Copin P, Bonvalet F, Bozi L, Cazals-Hatem D, Garzelli L, Panis Y, Weiss E, Castier Y, Bouhnik Y, Corcos O, Vilgrain V, Ronot M, Nuzzo A. Colonic involvement in acute mesenteric ischemia: prevalence, risk factors, and outcomes. Eur Radiol 2022; 32:2813-2823. [PMID: 34657969 DOI: 10.1007/s00330-021-08318-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aimed to investigate the prevalence, risk factors, and outcomes of colonic involvement in patients with acute mesenteric ischemia (AMI). METHODS CT scans from a prospective cohort of 114 AMI patients treated in an intestinal stroke center between 2009 and 2018 were blindly reviewed by two radiologists. Colon involvement was defined on CT scan by the presence of at least one of the following CT colonic features: wall thickening, pneumatosis, decreased wall enhancement, dilatation, or perforation. In addition, the clinical, biological, and radiological characteristics of patients with and without colonic involvement were compared to identify risk factors for colonic involvement on CT and its impact on morbidity and mortality. RESULTS Colonic involvement was identified in 32/114 (28%) patients with AMI, the right colon being more frequently involved (n = 29/32, 91%). Wall thickening (n = 27/32) was the most common CT finding. Occlusion of the inferior mesenteric artery was the only statistically significant risk factor for colonic involvement (35% vs. 15%, p = 0.02). Patients with colonic involvement on CT vs. those without had more frequently transmural colonic necrosis (13% vs. 0%, p = 0.006), short bowel syndrome (16% vs. 4%, p = 0.04), need for long-term parenteral support (19% vs. 5%, p = 0.03), and death during follow-up (22% vs. 10%, p = 0.03). DISCUSSION In patients with AMI, colonic involvement is associated with increased morbidity and mortality and should be carefully searched for during initial CT scan assessment. KEY POINTS • In a prospective cohort of acute mesenteric ischemia patients from an intestinal stroke center, 28% had an associated colonic involvement on CT. • Colonic involvement on CT most commonly affected the right colon, and the occlusion of the inferior mesenteric artery was the only risk factor. • Colonic involvement on CT was associated with increased morbidity and mortality and should be carefully searched for during initial CT scan assessment.
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Affiliation(s)
- Aida Ksouri
- Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
| | - Pauline Copin
- Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
| | - Fanny Bonvalet
- Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
| | - Lilian Bozi
- Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
| | | | - Lorenzo Garzelli
- Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
- Université de Paris, INSERM UMR 1148, Laboratory for Vascular Translational Science, 75018, Paris, France
| | - Emmanuel Weiss
- Université de Paris, INSERM UMR 1148, Laboratory for Vascular Translational Science, 75018, Paris, France
- Intensive Care Unit, Beaujon HospitalAPHP.Nord, 92110, Clichy, France
| | - Yves Castier
- Université de Paris, INSERM UMR 1148, Laboratory for Vascular Translational Science, 75018, Paris, France
- Department of Vascular Surgery, Bichat Hospital, APHP.Nord, 75018, Paris, France
| | - Yoram Bouhnik
- Université de Paris, INSERM UMR 1148, Laboratory for Vascular Translational Science, 75018, Paris, France
- Intestinal Stroke Center, Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
| | - Olivier Corcos
- Université de Paris, INSERM UMR 1148, Laboratory for Vascular Translational Science, 75018, Paris, France
- Intestinal Stroke Center, Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
- UMR 1149, Université de Paris, INSERM, 75018, Paris, CRI, France
| | - Maxime Ronot
- Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France.
- UMR 1149, Université de Paris, INSERM, 75018, Paris, CRI, France.
| | - Alexandre Nuzzo
- Université de Paris, INSERM UMR 1148, Laboratory for Vascular Translational Science, 75018, Paris, France
- Intestinal Stroke Center, Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, APHP.Nord, 92110, Clichy, France
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Mahfouz R, Kozai LA, Obeidat AE, Darweesh M, Mansour MM, Douglas MF, Berthiaume E. Congestive Heart Failure Is Associated With Worse Outcomes in Patients With Ischemic Colitis: A Nationwide Study. Cureus 2022; 14:e24308. [PMID: 35602840 PMCID: PMC9121910 DOI: 10.7759/cureus.24308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Ischemic colitis (IC) results from compromised blood flow to the colon. Risk factors include atrial fibrillation (A.Fib), peripheral artery disease (PAD), coronary artery disease (CAD), and congestive heart failure (CHF). However, few studies compared the mortality rate and colectomy between patients with IC with CHF and IC alone. OBJECTIVE We aim to investigate the possibility of worse outcomes in patients with IC and CHF compared to IC alone. METHODOLOGY Using the National Inpatient Sample database from 2016 to 2019, we obtained baseline demographic data, total hospital charge, rate of colectomy, length of hospital stay (LOS), and in-hospital mortality. Data were compared using a t-test and chi-squared. Odds ratios for comorbidities including A.Fib, CAD, PAD, end-stage renal disease, chronic obstructive pulmonary disease, hyperlipidemia, hypertension, diabetes, and cirrhosis were calculated. RESULTS 106,705 patients with IC were identified, among which 15,220 patients also had CHF. IC patients with CHF had a longer LOS (6.6 days vs 4.4 days; P<0.0001), higher total hospital charge ($71,359 vs $45,176; P<0.0001), higher mortality rate (8.5% vs 2.9%; P<0.0001), and higher colectomy rate (9.2% vs 5.9%; P<0.0001). CONCLUSION CHF is associated with poor outcomes in patients with IC. Our study showed an increased risk of mortality and colectomy compared to patients with IC alone. The findings suggest it may be warranted to have a heightened clinical suspicion of IC in patients with CHF who present with bleeding per rectum.
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Affiliation(s)
- Ratib Mahfouz
- Internal Medicine, Kent Hospital/Brown University, Warwick, USA
| | | | | | - Mohammad Darweesh
- Internal Medicine, East Tennessee State University, Johnson City, USA
| | - Mahmoud M Mansour
- Internal Medicine, University of Missouri School of Medicine, Columbia, USA
| | - Mustafa F Douglas
- Internal Medicine, Midwestern University Arizona College of Osteopathic Medicine, Sierra Vista, USA
| | - Eric Berthiaume
- Gastroenterology, Kent Hospital/Brown Unviersity, Warwick, USA
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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] [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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Alratrout H, Debroux E. Acute right-sided ischemic colitis in a COVID-19 patient: a case report and review of the literature. J Med Case Rep 2022; 16:135. [PMID: 35337362 PMCID: PMC8956143 DOI: 10.1186/s13256-022-03276-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/16/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction In addition to attacking the respiratory system, the coronavirus disease may attack the gastrointestinal tract in various ways, one of which is by creating a coagulopathy that may lead to acute ischemia of the bowel, increasing morbidity and mortality rates in these patients. Presentation of case We present a case of a white 72-year-old European male, who was admitted to the intensive care unit after developing COVID-19-induced acute respiratory distress syndrome. On the third week, despite a favorable evolution of his respiratory symptoms, the patient became clinically septic; laboratory findings showed an augmentation of his d-dimer, fibrinogen, C-reactive protein, and procalcitonin levels. Imaging showed signs of ischemia of the right colon. The patient was taken to the operating room; only the right side of his colon was ischemic, with a well demarcated cut-off. A laparoscopic right hemicolectomy with a terminal ileostomy was performed. The patient was able to go home 2 weeks after surgery. Discussion and conclusion Ischemic colitis is an uncommon pathology in the general population, and is rare in COVID-19 patients. Most cases of ischemic colitis in COVID-19 patients in the literature were limited to the left colon, with < 10 cases involving the right colon. Accurate and quick diagnosis with appropriate management is the key to avoid any mortality in those patients who are already weakened by the coronavirus.
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Affiliation(s)
- Hefzi Alratrout
- Department of General Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.
| | - Eric Debroux
- Department of Digestive Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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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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Sreepriya P, Kumar A, Paswan SS, Anand U, Bharti S, Ranjan R. Invasive investigation in cases of visceral AVM may be fatal: A rare case report. Int J Surg Case Rep 2022; 93:106907. [PMID: 35286980 PMCID: PMC8924641 DOI: 10.1016/j.ijscr.2022.106907] [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: 12/14/2021] [Revised: 02/27/2022] [Accepted: 02/27/2022] [Indexed: 02/07/2023] Open
Abstract
Introduction and importance Visceral arteriovenous malformations (AVMs) are extremely rare with only a few cases described in the literature. We have encountered a mesenteric AVM in a 23-year-old girl. Considering the rarity of this entity and diagnostic dilemma, we herein describe a case of mesenteric AVM along with the review of literature. Case presentation A 23-year-old female presented with pain and lump in lower abdomen. During her workup to conclude a final diagnosis, Fine needle aspiration cytology (FNAC) was done. Post FNAC patient went into shock and immediately emergency laparotomy was done. The bleeding mass was resected along with involved gut and anastomosis was done. Histopathology suggested AVM. She was doing well at 2 months of follow up. Clinical discussion AVM is the rare cause of ischaemic colitis. It can create a diagnostic dilemma with its unusual presentation and its rarity even for both radiologists and surgeons. Usually such malformation reported after trauma or any surgical intervention, but in our case there was no such history of trauma which makes this case more interesting. Invasive investigation is recommended in such condition but needs to be very cautious. As in this index case invasive procedure lead to severe bleeding. Although definitive treatment are embolization and surgery. Conclusion Invasive procedure should be avoided in case of AVM. If angiography is not available its mandatory to keep operating room ready before any invasive procedure. Only few cases of visceral arteriovenous malformations are reported in the literature. Invasive investigation should be avoided in case of AVM. Because of more lymphatic component sometimes contrast enhancement is not obvious. The early surgical intervention is wise decision even in case of diagnosis dilemma.
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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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Vigorita V, García-Señoráns MP, Pellino G, Troncoso Pereira P, de San Ildefonso Pereira A, Moncada Iribarren E, Sánchez-Santos R, Casal Núñez JE. Ischemic colitis. Does right colon location mean worst prognosis? Cir Esp 2022; 100:74-80. [PMID: 35120849 DOI: 10.1016/j.cireng.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/08/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Most patients with ischemic colitis have a favourable evolution; nevertheless, the location in the right colon has been associated with a worse prognosis. The purpose of this study is to compare the clinical presentation and results of right colon ischemic colitis (CICD) with ischemic colitis of other colonic segments (non-CIDC). METHODS Retrospective, observational study of patients admitted to our hospital with ischemic colitis between 1993 and 2014, identified through a computerized search of ICD9 codes. They were divided into 2 groups: CICD and non-CICD. Comorbidities, clinical presentation, need for surgery, and mortality were compared. Multivariate analysis was performed using logistic regression adjusting for age and sex. Statistical significance was established at a value of P < 0.05. RESULTS A total of 204 patients were identified, 61 (30%) with CICD; 61% of CICD patients required surgery compared to 22% of non-CICD patients (P < 0.001). Differences in post-surgical mortality (32% vs 55%) and overall mortality (20% vs 15%) were not statistically significant. CICD patients had more commonly unfavourable outcomes than non-CICD patients (61% vs 25%, P < 0.001). The odds ratio (OR) for surgery was 5.28 and 4.47 for unfavourable outcomes for patients with CICD. CONCLUSIONS CICD patients have a worse prognosis than non-CICD patients, 5 times more likely to need surgery and 4 times more likely to have unfavourable outcomes.
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Affiliation(s)
- Vincenzo Vigorita
- Unidad de Cirugía Colorrectal, Hospital Álvaro Cunqueiro, Vigo, Spain
| | | | - Gianluca Pellino
- Unidad de Cirugía Colorrectal, Hospital Vall d'Hebron, Barcelona, Spain
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Ko SF, Chen HH, Huang CC, Lin LH, Ng SH, Lee YW. Phlebosclerotic colitis: an analysis of clinical and CT findings in 29 patients with long-term follow-up. Insights Imaging 2022; 13:19. [PMID: 35092508 PMCID: PMC8800981 DOI: 10.1186/s13244-022-01159-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/11/2022] [Indexed: 12/24/2022] Open
Abstract
Background Phlebosclerotic colitis (PC) is a rare form of nonthrombotic colonic ischemia. This retrospective study analyzed the clinical findings and temporal CT changes in 29 PC patients with long-term follow-up. Methods Twenty-nine patients with characteristic CT features of PC collected between 1997 and 2020 were stratified into the acute abdomen group (AA-group) (n = 10), chronic-progressive group (CP-group) (n = 14) and chronic-stable group (CS-group) (n = 5). Clinical and CT changes during follow-up, comorbidities and final outcomes were compared. Results The AA-group exhibited a significantly thicker colonic wall and more involved segments and pericolic inflammation than the CP-group and CS-group on initial CT (p = < 0.001–0.031). Seven patients in the AA-group who underwent right hemicolectomy had no recurrence during follow-up (mean ± SD, 7.1 ± 3.3 years), and the remaining three patients with renal or hepatic comorbidities who underwent conservative treatment died within 14 days. The CP-group showed significantly higher frequencies of chronic renal failure, urinary tract malignancies and liver cirrhosis than the AA-group (p = 0.005–0.008). In addition, CT follow-up (7.9 ± 4.3 years) showed significant increases in mesenteric venous calcifications, colonic wall thickening and involved colonic segments (p = 0.001–0.008) but conservative treatments were effective. The CS-group remained unchanged for years (8.2 ± 3.9 years). Conclusions Early surgery offered excellent prognosis in PC-related acute abdomen denoted by marked right colonic wall thickening and pericolic inflammation on CT. Conservative treatments with a wait-and-watch strategy were appropriate for CP-PC and CS-PC, albeit CP-PC harbored significant increases in calcifications, colonic wall thickening and affected segments in long-term CT follow-up.
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Bad blood: ischemic conditions of the large bowel. Curr Opin Gastroenterol 2022; 38:72-79. [PMID: 34871196 DOI: 10.1097/mog.0000000000000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Colon ischemia is the most common form of intestinal ischemic injury and is seen frequently in an elderly population. This disease is usually self-limited, and many causes have been identified. The recent literature has focused on estimates of prognosis, triaging appropriate level of care, and identification of optimal treatments. In this review, we will address our current understanding of colon ischemia including epidemiology, pathophysiology, segmental distribution, presentation, diagnosis, and management. RECENT FINDINGS Research has recently been focused on factors associated with poor outcome. The medical comorbidities identified include chronic obstructive pulmonary disease (COPD), hepatic cirrhosis, and chronic aspirin use. Serological markers are noninvasive tools that can triage severity. Recent studies have shown procalcitonin, C-reactive protein, D-dimer, and neutrophil counts can help predict those at greatest risk for poor outcome. The timing of colonoscopy relative to symptomatic onset also can help predict severity. Early colonoscopy allows for quicker identification of ischemic stigmata, reducing the chance of misdiagnosis and potentially unnecessary and harmful treatment. The treatment of colon ischemia has classically been conservative with antimicrobials reserved for those with moderate or severe disease. Recent retrospective analysis calls into question the utility of antibiotics in the treatment of colon ischemia, although the data is not convincing enough to advise against antimicrobial treatment in patients with severe and fulminant disease. SUMMARY It is an exciting time for research focused on colon ischemia. With an improved knowledge, awareness of associated risk factors and predictors of severity, clinicians now have enhanced clinical tools to diagnose and triage patients earlier in the disease. This should help institute prompt and appropriate therapies ultimately improving outcomes.
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Uhlenhopp DJ, Ramachandran R, Then E, Parvataneni S, Grantham T, Gaduputi V. COVID-19-Associated Ischemic Colitis: A Rare Manifestation of COVID-19 Infection-Case Report and Review. J Investig Med High Impact Case Rep 2022; 10:23247096211065625. [PMID: 35343847 PMCID: PMC8966066 DOI: 10.1177/23247096211065625] [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: 01/08/2023] Open
Abstract
Following the first report of COVID-19 infection in December 2019 as a respiratory illness, it has proven to be a multisystem disease. There are few reported cases of ischemic colitis with COVID-19 infection in the medical literature to date and we have limited understanding of its pathophysiology. We report 2 cases of ischemic colitis as the only manifestation of COVID-19. In addition, we review the current limited literature regarding COVID-19-associated ischemic colitis.
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Affiliation(s)
| | | | - Eric Then
- The Brooklyn Hospital Center, NY, USA
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Kawamura T, Sakiyama N, Tanaka K, Yokota I, Uno K, Yasuda K. Ischemic Colitis Caused by Bowel Preparation for Colonoscopy. Gastroenterology Res 2021; 14:296-303. [PMID: 34804274 PMCID: PMC8577598 DOI: 10.14740/gr1461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background Ischemic colitis is an adverse event which may occur during bowel preparation for colonoscopy. This study aims to clarify both the incidence and the risk factors of this complication. Methods This was a single-center, retrospective, observational study. All outpatients who were prescribed standardized preparation drugs for colonoscopy at the Kyoto Second Red Cross Hospital between November 2011 and March 2020 were included in the study. A split bowel preparation was carried out as follows; magnesium citrate with or without sodium picosulfate hydrate was/were used as a preparation drug on the day before the colonoscopy, and polyethylene glycol electrolyte solution or sodium phosphate was used on the morning of the endoscopic procedure. Patients were extracted from the electronic medical records and matched with the endoscopy database by examination date and hospital identification number. Following the endoscopic findings, both the incidence and risk factors for ischemic colitis arising after bowel preparation were examined. Results Among the 14,924 patients analyzed, ischemic colitis was observed in 14 patients (0.09%). Multivariate analysis revealed that old age (≥ 75 years old) and strong preparation (magnesium citrate with sodium picosulfate and polyethylene glycol electrolyte solution) for constipated patients were independent risk factors for ischemic colitis (odds ratio: 3.64 (95% confidence interval (CI): 1.36 - 9.77) and 4.27 (95% CI: 1.45 - 12.53), respectively). Conclusions The age 75 years and above and strong preparation for patients with constipation were independent risk factors for ischemic colitis prior to colonoscopy. Careful attention should be paid to bowel preparation before colonoscopy for patients aged ≥ 75 years and for those with constipation.
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Affiliation(s)
- Takuji Kawamura
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Naokuni Sakiyama
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Kiyohito Tanaka
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Isao Yokota
- Department of Biostatistics, Hokkaido University, Sapporo, Japan
| | - Koji Uno
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Kenjiro Yasuda
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
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Sadalla S, Lisotti A, Fuccio L, Fusaroli P. Colonoscopy-related colonic ischemia. World J Gastroenterol 2021; 27:7299-7310. [PMID: 34876790 PMCID: PMC8611204 DOI: 10.3748/wjg.v27.i42.7299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/06/2021] [Accepted: 10/20/2021] [Indexed: 02/06/2023] Open
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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Lorenzo D, Barthet M, Serrero M, Beyer L, Berdah S, Birnbaum D, Vitton V, Gonzalez JM. Severe acute ischemic colitis: What is the place of endoscopy in the management strategy? Endosc Int Open 2021; 9:E1770-E1777. [PMID: 34790544 PMCID: PMC8589548 DOI: 10.1055/a-1561-2259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and study aims Ischemic colitis (IC) is potentially lethal. Clinical and biology information and results of computed tomography (CT) scan and/or colonoscopy are used to assess its severity. However, decision-making about therapy remains a challenge. Patients and methods This was a retrospective, single-center study between 2006 and 2015. Patients with severe IC who underwent endoscopic evaluation were included. The aims were to determine outcomes depending on endoscopic findings and assess the role of endoscopy in the management. Results A total of 71 patients were included (men = 48 (68%), mean age = 71 ± 13 years). There was hemodynamic instability in 29 patients (41 %) and severity signs on CT scan in 18 (38 %). Twenty-nine patients (41 %) underwent surgery and 24 (34 %) died. The endoscopic grades were: 15 grade 1 (21 %), 32 grade 2 (45 %), and 24 grade 3 (34%). Regarding patients with grade 3 IC, 55 % had hemodynamic instability, 58 % had severity signs on CT scan, 68 % underwent surgery, and 55 % died. The decision to perform surgery was based on hemodynamic status in 62 % of cases, CT scan data in 14 %, endoscopic findings in 10 %, and other in 14 %. Colectomy was more frequent in patients with grade 3 IC ( P < 0.05). A mismatch between mucosal aspect (necrosis) and serous (normal) was observed in 13 patients (46 %). Risk factors for colectomy in univariate analysis were aortic aneurysm surgery, hemodynamic instability, no colic enhancement on CT scan, and endoscopic grade 3. Risk factors for mortality in multivariate analysis were hemodynamic instability, colectomy, and Charlson score > 5 ( P < 0.05). Conclusions This study suggests a low impact of endoscopy on surgical decision making. Hemodynamic instability was the first indication for colectomy. A discrepancy between endoscopic mucosal (necrosis) and surgical serous (normal) aspects was frequently noted.
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Affiliation(s)
- Diane Lorenzo
- Department of Gastroenterology, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
| | - Marc Barthet
- Department of Gastroenterology, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
| | - Mélanie Serrero
- Department of Gastroenterology, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
| | - Laura Beyer
- Department of Visceral Surgery, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
| | - Stéphane Berdah
- Department of Visceral Surgery, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
| | - David Birnbaum
- Department of Visceral Surgery, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
| | - Véronique Vitton
- Department of Gastroenterology, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
| | - Jean Michel Gonzalez
- Department of Gastroenterology, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
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Chronic obstructive pulmonary disease is associated with worse outcomes in ischemic colitis: a nationwide retrospective study. Int J Colorectal Dis 2021; 36:2455-2461. [PMID: 33987734 DOI: 10.1007/s00384-021-03935-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ischemic colitis (IC) occurs when the blood supply of the large intestine becomes compromised. Several cardiovascular conditions, such as coronary artery disease, congestive heart failure, and atrial fibrillation, are well-established risk factors for the development of IC. The effects of pulmonary conditions, namely chronic obstructive pulmonary disease (COPD), on IC have not been well studied. AIMS Our aim was to elucidate if the presence of COPD worsened outcomes in patients with IC. METHODS Retrospective analysis of patients hospitalized with IC in 2016 was evaluated using the National Inpatient Sample database. Baseline demographic data, length of hospital stay (LOS), total hospital cost/charge, rates of colectomy, and in-hospital mortality were extracted from the database. Categorical variables were compared using the chi-square test and continuous variables were compared using the t-test. RESULTS A total of 25,035 patients with IC were identified while 4482 of these patients also had COPD. We found that IC patients with COPD had a longer LOS (5.8 days vs 4.4 days; P<0.01), higher total hospital charge ($56,682 vs $42,365; P<0.01), higher total hospital cost ($13,603 vs $10,238; P<0.01), higher mortality rate (6.5% vs 3.1%; P<0.01), and higher colectomy rate (5.1% vs 3.7%; P<0.01). CONCLUSIONS The presence of COPD portends poor outcomes in patients with IC. This was evidenced by increased risk of death and increased risk of undergoing colectomy. Given these findings, patients with COPD warrant closer observation. We advocate that COPD be considered as part of the risk assessment of patients with acute IC who need surgical intervention.
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Maimone A, De Ceglie A, Siersema PD, Baron TH, Conio M. Colon ischemia: A comprehensive review. Clin Res Hepatol Gastroenterol 2021; 45:101592. [PMID: 33662779 DOI: 10.1016/j.clinre.2020.101592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023]
Abstract
The clinical and endoscopic features of colon ischemia (CI) are non-specific. CI is correctly identified at the time of presentation in only 9% of patients is. The true incidence is likely underestimated because many mild cases resolve spontaneously without medical treatment. Furthermore, since most cases of CI are transient, and no specific cause is detected they are often considered to be "idiopathic". In the setting of severe CI correct diagnosis and prompt recognition and therapy as well as identification of underlying causes are crucial for a favourable outcome. Although less severe, mild cases may present with similar symptoms, the prognosis and management are completely different and managed conservatively rather than with surgery. Unfortunately, data from most studies and current guidelines do not provide recommendations on the long-term management of CI or about the need for endoscopic follow-up to detect the development chronic, recurrent and/or ischemic colonic strictures. In this review, we focus on the definition of CI, its aetiology, and patterns of presentation. We highlight the pharmacological and/or endoscopic management as determined severity of disease that allow for improved outcomes. Prompt recognition and treatment using a multidisciplinary approach are essential for successful management of severe CI because mortality rates are significantly higher when the diagnosis is delayed.
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Affiliation(s)
- Antonella Maimone
- Department of Gastroenterology, General Hospital, Sanremo, IM, Italy
| | | | - Peter D Siersema
- Department of Gastroenterology and Hepatology (Route 763), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Massimo Conio
- Department of Gastroenterology, General Hospital, Sanremo, IM, Italy; Department of Gastroenterology, Santa Corona General Hospital, Pietra Ligure, SV, Italy.
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Tome J, Maselli DB, Im R, Amdahl MB, Pfeifle D, Hagen C, Halland M. A case of hemolytic uremic syndrome caused by Shiga toxin-producing Escherichia coli after pericardiectomy. Clin J Gastroenterol 2021; 15:123-127. [PMID: 34677733 DOI: 10.1007/s12328-021-01539-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/14/2021] [Indexed: 02/04/2023]
Abstract
The majority of cases of Shiga toxin-producing Escherichia coli are self-limited; however, the infection can occasionally be complicated by more severe phenomena, such as thrombotic microangiopathy, with resultant end-organ damage to the kidneys, colon, nervous system, and various other tissues. Shiga toxin-induced hemolytic uremic syndrome (ST-HUS)-the constellation of thrombocytopenia, hemolysis, and renal failure resulting from thrombotic microangiopathy in a subset of infections producing the Shiga toxin-is classically observed in the pediatric population. Nevertheless, the diagnosis should be considered in adults with this presentation, and especially in those with colonic findings suggestive of ischemia. ST-HUS must also be distinguished from other thrombotic microangiopathies and related conditions, such as disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, and complement-mediated HUS, as these diagnoses prompt alternate management strategies. Here, we present a case of ST-HUS in a gentleman following pericardiectomy who was infected with non-O157:H7 E. coli producing Shiga toxin 2.
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Affiliation(s)
- June Tome
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daniel Barry Maselli
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Roeun Im
- Division of Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Daniel Pfeifle
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Magnus Halland
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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