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Outcomes of patients with ischemic colitis causing severe hematochezia managed medically or surgically

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Abstract

Purpose

To compare short- and long-term outcomes of hospitalized patients with ischemic colitis (IC) presenting with severe hematochezia and treated medically or colectomy and also those with inpatient vs. outpatient start of hematochezia.

Methods

A retrospective analysis of prospectively collected data for IC patients hospitalized for severe hematochezia from two teaching hospitals was done from 1994 to 2020, with the diagnosis of IC made colonoscopically and confirmed histologically.

Results

Ninety-seven patients initially all had medical management for IC. Seventy-two (74.2%) were stable and had no further bleeding; 17 (17.5%) had colon resection; and 8 were critically ill and not surgical candidates. Surgical patients and non-surgical candidate had higher comorbidity scores; received more red blood cell (RBC) transfusion (median (IQR) 5 (3–10) vs. 4.5 (3–6.5) vs. 1 (0–4) units, p < 0.001); had significantly longer hospital and ICU days; had higher severe complication rates (35.3% vs. 100%. vs. 5.6%, p < 0.001); and had higher 30-day all-cause mortality rates (23.5% vs. 87.5% vs. 0, p < 0.001). Inpatients developing IC hemorrhage had more RBC transfusions, more complications, longer hospital stays, and higher mortality than patients whose IC bleeding started as outpatients.

Conclusions

The majority of IC patients hospitalized for severe hematochezia were successfully treated medically. Patients who were not surgical candidate had the highest rates of severe complications and mortality. Surgical patients and those who were not surgical candidate had worse outcomes than the medical group. Patients with inpatient start of bleeding from IC had significantly worse outcomes than those with outpatient start of bleeding.

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Funding

This work was supported by Veterans Administration Clinical Merit Review Research Grant (grant number 5I01CX001403) and the National Institutes of Health—National Institute of Diabetes and Digestive and Kidney (NIH—NIDDK) UCLA (CURE): DDRCC Human Studies Core (grant number P30DK41301).

Author information

Authors and Affiliations

  1. CURE Hemostasis Research Unit and the UCLA Digestive Diseases Research Core Center (UCLA: DDRCC), Los Angeles, CA, USA

    Thongsak Wongpongsalee, Usah Khrucharoen, Dennis M. Jensen, Rome Jutabha, Mary Ellen Jensen & Gail Thibodeau

  2. David Geffen School of Medicine at University of California, Los Angeles, CA, USA

    Thongsak Wongpongsalee, Usah Khrucharoen, Dennis M. Jensen, Rome Jutabha, Mary Ellen Jensen & Gail Thibodeau

  3. Vatche and Tamar Manoukian Division of Digestive Diseases and Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA

    Thongsak Wongpongsalee, Usah Khrucharoen, Dennis M. Jensen, Rome Jutabha, Mary Ellen Jensen & Gail Thibodeau

  4. Division of Trauma Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand

    Thongsak Wongpongsalee

  5. Division of Digestive Diseases and Department of Medicine, Veterans Administration Greater Los Angeles Healthcare System, Building 115, Room 318, 11301 Wilshire Boulevard, Los Angeles, CA, 90073-1003, USA

    Usah Khrucharoen, Dennis M. Jensen, Mary Ellen Jensen & Gail Thibodeau

  6. Division of Gastrointestinal and Hepatology and Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA

    Rome Jutabha

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  1. Thongsak Wongpongsalee
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  3. Dennis M. Jensen
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  4. Rome Jutabha
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  5. Mary Ellen Jensen
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Contributions

Thongsak Wongpongsalee: study design, acquisition of data, analysis and interpretation of the data, and drafting of the article. Usah Khrucharoen: acquisition of data, analysis and interpretation of the data, drafting of the article, and critical revision of the manuscript. Dennis M. Jensen: study conception and design, acquisition of data, interpretation of the data, and critical revision of the manuscript. Rome Jutabha: interpretation of the data and critical revision of the manuscript. Mary Ellen Jensen: analysis of the data and critical revision of the manuscript. Gail Thibodeau: interpretation of the data and critical revision of the manuscript.

Corresponding author

Correspondence to Dennis M. Jensen.

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All patients in this study had been enrolled in Institutional Review Board (IRB)–approved prospective studies of severe hematochezia at Ronald Reagan UCLA Medical Center or VA Greater Los Angeles Healthcare System.

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The authors declare no competing interests.

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Wongpongsalee, T., Khrucharoen, U., Jensen, D.M. et al. Outcomes of patients with ischemic colitis causing severe hematochezia managed medically or surgically. Langenbecks Arch Surg 407, 1625–1636 (2022). https://doi.org/10.1007/s00423-022-02441-8

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  • DOI: https://doi.org/10.1007/s00423-022-02441-8

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