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World Journal of Surgery

, 35:2549 | Cite as

Ischemic Colitis: Clinical Presentation, Localization in Relation to Risk Factors, and Long-Term Results

  • Philippe M. Glauser
  • Petra Wermuth
  • Gieri Cathomas
  • Evelyn Kuhnt
  • Samuel A. Käser
  • Christoph A. MaurerEmail author
Article

Abstract

Background

Ischemic colitis is commonly thought to occur most often in the left hemicolon close to the splenic flexure owing to insufficient blood supply near Griffith’s point. This study investigates the colorectal localization pattern, the risk factors, and the long-term outcome of histologically proven ischemic colitis.

Methods

Between 1996 and 2004, a total of 49 patients with a median age of 69 years (range 26–94 years) with colonoscopically assessed and histologically proven ischemic colitis were identified on behalf of the pathology database. Long-term results of 43 patients were evaluated retrospectively after a median interval of 79 months (range 6–163 months).

Results

In 27 patients (55%) more than one location was affected. We found 98 affected locations in 49 patients. The distribution of ischemic colitis in our group shows no significantly preferred location. In an exploratory analysis, the cecum, ascending colon, and right flexure were affected significantly more often if intake of a nonsteroidal antiinflammatory drug (NSAID) is documented. There was no association between the location of ischemic colitis and a history of smoking, peripheral artery occlusive disease, coronary heart disease, diabetes, or malignant tumor.

Conclusions

Ischemic colitis seems not to have a predisposing site of occurrence in the colorectum, especially Griffith’s point which was not afflicted significantly more often than other sites. Frequently, ischemic colitis afflicts more than one colonic location. In patients being treated with NSAIDs, ischemic colitis was observed significantly more often in the right hemicolon. Recurrence of ischemic colitis seems to be rare.

Keywords

Coronary Heart Disease Inflammatory Bowel Disease Amyloidosis Splenic Flexure Inferior Mesenteric Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflicts of interest

The authors have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Elder K, Lashner BA, Al Solaiman F (2009) Clinical approach to colonic ischemia. Cleve Clin J Med 76:401–409PubMedCrossRefGoogle Scholar
  2. 2.
    Longstreth GF (1997) Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 92:419–424PubMedGoogle Scholar
  3. 3.
    Vernava AM 3rd, Moore BA, Longo WE et al (1997) Lower gastrointestinal bleeding. Dis Colon Rectum 40:846–858PubMedCrossRefGoogle Scholar
  4. 4.
    Green BT, Tendler DA (2005) Ischemic colitis: a clinical review. South Med J 98:217–222PubMedCrossRefGoogle Scholar
  5. 5.
    Theodoropoulou A, Koutroubakis IE (2008) Ischemic colitis: clinical practice in diagnosis and treatment. World J Gastroenterol 14:7302–7308PubMedCrossRefGoogle Scholar
  6. 6.
    Scharff JR, Longo WE, Vartanian SM et al (2003) Ischemic colitis: spectrum of disease and outcome. Surgery 134:624–629; discussion 629–630Google Scholar
  7. 7.
    MacDonald PH (2002) Ischaemic colitis. Best Pract Res Clin Gastroenterol 16:51–61PubMedCrossRefGoogle Scholar
  8. 8.
    Higgins PD, Davis KJ, Laine L (2004) Systematic review: the epidemiology of ischaemic colitis. Aliment Pharmacol Ther 19:729–738PubMedCrossRefGoogle Scholar
  9. 9.
    Shaw RS, Green TH Jr (1953) Massive mesenteric infarction following inferior mesenteric-artery ligation in resection of the colon for carcinoma. N Engl J Med 248:890–891PubMedCrossRefGoogle Scholar
  10. 10.
    Smith RF, Szilagyi DE (1960) Ischemia of the colon as a complication in the surgery of the abdominal aorta. Arch Surg 80:806–821PubMedGoogle Scholar
  11. 11.
    Izbicki JR, Schneider CG, Kastl S (2003) Partial ischemia: occlusive and nonocclusive mesenteric ischemia, ischemic colitis, systemic lupus erythematosus. Chirurg 74:413–418PubMedCrossRefGoogle Scholar
  12. 12.
    Zelenock GB, Strodel WE, Knol JA et al (1989) A prospective study of clinically and endoscopically documented colonic ischemia in 100 patients undergoing aortic reconstructive surgery with aggressive colonic and direct pelvic revascularization, compared with historic controls. Surgery 106:771–779PubMedGoogle Scholar
  13. 13.
    Brown DN, Rosenholtz MJ, Marshall JB (1994) Ischemic colitis related to cocaine abuse. Am J Gastroenterol 89:1558–1561PubMedGoogle Scholar
  14. 14.
    Deana DG, Dean PJ (1995) Reversible ischemic colitis in young women: association with oral contraceptive use. Am J Surg Pathol 19:454–462PubMedCrossRefGoogle Scholar
  15. 15.
    Patel YJ, Scherl ND, Elias S et al (1992) Ischemic colitis associated with psychotropic drugs. Dig Dis Sci 37:1148–1149PubMedCrossRefGoogle Scholar
  16. 16.
    Johnson TD, Berenson MM (1991) Methamphetamine-induced ischemic colitis. J Clin Gastroenterol 13:687–689PubMedCrossRefGoogle Scholar
  17. 17.
    Knudsen JF, Friedman B, Chen M et al (1998) Ischemic colitis and sumatriptan use. Arch Intern Med 158:1946–1948PubMedCrossRefGoogle Scholar
  18. 18.
    Tada H, Saitoh S, Nakagawa Y et al (1996) Ischemic colitis during interferon-alpha treatment for chronic active hepatitis C. J Gastroenterol 31:582–584PubMedCrossRefGoogle Scholar
  19. 19.
    Green BT, Branch MS (2003) Ischemic colitis in a young adult during sickle cell crisis: case report and review. Gastrointest Endosc 57:605–607PubMedCrossRefGoogle Scholar
  20. 20.
    Kistin MG, Kaplan MM, Harrington JT (1978) Diffuse ischemic colitis associated with systemic lupus erythematosus: response to subtotal colectomy. Gastroenterology 75:1147–1151PubMedGoogle Scholar
  21. 21.
    Yee NS, Guerry DT, Lichtenstein GR (2000) Ischemic colitis associated with factor V Leiden mutation. Ann Intern Med 132:595–596PubMedGoogle Scholar
  22. 22.
    Richardson SC, Willis J, Wong RC (2003) Ischemic colitis, systemic lupus erythematosus, and the lupus anticoagulant: case report and review. Gastrointest Endosc 57:257–260PubMedCrossRefGoogle Scholar
  23. 23.
    Byrd RL, Cunningham MW, Goldman LI (1987) Nonocclusive ischemic colitis secondary to hemorrhagic shock. Dis Colon Rectum 30:116–118PubMedCrossRefGoogle Scholar
  24. 24.
    Longo WE, Ballantyne GH, Gusberg RJ (1992) Ischemic colitis: patterns and prognosis. Dis Colon Rectum 35:726–730PubMedCrossRefGoogle Scholar
  25. 25.
    Binns JC, Isaacson P (1978) Age-related changes in the colonic blood supply: their relevance to ischaemic colitis. Gut 19:384–390PubMedCrossRefGoogle Scholar
  26. 26.
    Meyers MA (1976) Griffiths’ point: critical anastomosis at the splenic flexure. Significance in ischemia of the colon. AJR Am J Roentgenol 126:77–94PubMedGoogle Scholar
  27. 27.
    Steward JA, Rankin FW (1933) Blood supply of the large intestine: its surgical considerations. Arch Surg 26:843–891Google Scholar
  28. 28.
    Bower TC (1993) Ischemic colitis. Surg Clin North Am 73:1037–1053PubMedGoogle Scholar
  29. 29.
    Yamazaki T, Shirai Y, Tada T et al (1997) Ischemic colitis arising in watershed areas of the colonic blood supply: a report of two cases. Surg Today 27:460–462PubMedCrossRefGoogle Scholar
  30. 30.
    Price AB (1990) Ischaemic colitis. Curr Top Pathol 81:229–246PubMedGoogle Scholar
  31. 31.
    Hunt RH, Buchanan JD (1979) Transient ischaemic colitis: colonoscopy and biopsy in diagnosis. J R Nav Med Serv 65:15–19PubMedGoogle Scholar
  32. 32.
    Dignan CR, Greenson JK (1997) Can ischemic colitis be differentiated from C. difficile colitis in biopsy specimens? Am J Surg Pathol 21:706–710PubMedCrossRefGoogle Scholar
  33. 33.
    Gandhi SK, Hanson MM, Vernava AM et al (1996) Ischemic colitis. Dis Colon Rectum 39:88–100PubMedCrossRefGoogle Scholar
  34. 34.
    Hunter GC, Guernsey JM (1988) Mesenteric ischemia. Med Clin North Am 72:1091–1115PubMedGoogle Scholar
  35. 35.
    Brandt LJ, Feuerstadt P, Blaszka MC (2010) Anatomic patterns, patient characteristics, and clinical outcomes in ischemic colitis: a study of 313 cases supported by histology. Am J Gastroenterol 105:2245–2252PubMedCrossRefGoogle Scholar
  36. 36.
    Zou X, Cao J, Yao Y et al (2009) Endoscopic findings and clinicopathologic characteristics of ischemic colitis: a report of 85 cases. Dig Dis Sci 54:2009–2015PubMedCrossRefGoogle Scholar
  37. 37.
    Acosta S, Ogren M, Sternby NH et al (2006) Fatal colonic ischemia: a population-based study. Scand J Gastroenterol 41:1312–1319PubMedCrossRefGoogle Scholar
  38. 38.
    Carlson RM, Madoff RD (2011) Is “ischemic” colitis ischemic? Dis Colon Rectum 54:370–373PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Philippe M. Glauser
    • 1
  • Petra Wermuth
    • 1
  • Gieri Cathomas
    • 2
  • Evelyn Kuhnt
    • 3
  • Samuel A. Käser
    • 1
  • Christoph A. Maurer
    • 1
    Email author
  1. 1.Department of SurgeryHospital of Liestal (affiliated with the University of Basel)LiestalSwitzerland
  2. 2.Institute of PathologyHospital of LiestalLiestalSwitzerland
  3. 3.Clinical Trial Center, Faculty of MedicineUniversity of LeipzigLeipzigGermany

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