Ischemic Colitis in Chronic Intermittent Peritoneal Dialysis

Koren, G; Aladjem, M; Militiano, J.; Seegal, Beatrice Carrier; Jonash, A.; Boichis, H

doi:10.1159/000183168

Cited by 18 publications

(5 citation statements)

References 6 publications

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“…In recent years, non-occlusive mesenteric ischemia (NOMI) has become increasingly recognized as a highly dangerous complication in both hemodialysis [1,2,3,4,5,6,7,8,9,10,11,12] and peritoneal dialysis patients, young and old alike [13,14,15]. Undoubtedly, NOMI is seen far more often in hemodialysis patients, with intradialytic hypotension being the major precipitating factor behind the development of NOMI among these patients [1, 2,4,5,6, 11].…”

Section: Introductionmentioning

confidence: 99%

Non-Occlusive Mesenteric Ischemia in Chronically Dialyzed Patients: A Disease with Multiple Risk Factors

et al. 2005

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Background: Non-occlusive mesenteric ischemia (NOMI) can be a fatal complication in dialysis patients. Intradialytic hypotension is usually the precipitating factor. The occurrence of 16 cases in 5 years (1998–2002), compared with only 4 in previous years, led us to investigate other risk factors contributing to NOMI. A control group of stable hemodialysis patients was used for comparison. Results: 20 patients were studied: 17 diagnosed surgically, and 3 clinically. The mean age was 70.8 ± 1.8 years, and the male:female ratio 7:13. Nineteen patients were on hemodialysis. Clinically overt atherosclerosis was present in 17 patients. Preceding dialysis-associated hypotension was identified in all patients studied and access thrombosis in 6 patients. In all patients, abdominal pain was the presenting symptom. Initial abdominal examination was unimpressive in 16 patients. The hemoconcentration, leukocytosis and metabolic acidosis were the most prominent laboratory findings. 5/11 abdominal sonograms showed intestinal pathology. 2/3 angiographies were diagnostic. Three patients responded to early fluid challenge and did not require surgery. Pathology was related to the area of the superior mesenteric artery in all 15 patients operated. Twelve (60%) patients died from the event. The 1-year mortality rate was 17/20 patients (85%). Possible contributing factors, other than dialysis-associated hypotension, included: high-dose recombinant human erythropoietin (rhEPO) therapy (179 ± 35 vs. 116 ± 10 U/kg/week in the control group, p < 0.05); metastatic calcifications (abdominal aorta 14/14, aortic valve 11/18; medial calcification of mesenteric arteries in 2/11 pathology specimens); digoxin, and hypoalbuminemia. Conclusions: The increased incidence of NOMI in dialysis patients may be related to overly aggressive rhEPO therapy and the unsuspected presence of mesenteric arterial medial calcifications. Identification of patients at risk, prevention of intradialytic hypotension and a controlled increase in dry weight may help to reduce the incidence of NOMI in chronically dialyzed patients.

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Section: Introductionmentioning

confidence: 99%

Non-Occlusive Mesenteric Ischemia in Chronically Dialyzed Patients: A Disease with Multiple Risk Factors

et al. 2005

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“…Microbiological findings, however, may discriminate between necrosis and perforation. While we and others (14,15) could not grow any organisms from the cloudy dialysate of our patient with nonperforated necrosis, Wakeen and co-workers found polymicrobial peritonitis in 12 of their 15 patients with visceral perforation (6). All authors conclude that, in contrast to our approach to using the PD catheter for peritoneal lavage, it must always be removed at once.…”

Section: Discussionmentioning

confidence: 51%

An Important Differential Diagnosis in Capd Patients with Sudden Onset of Fever, Vomiting, Abdominal Pain, and Cloudy Dialysate

Prischl¹,

Wallner

Schauer

et al. 1999

Perit Dial Int

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“…Isolated case reports have described the development of ischemic colitis in conjunction with mild allergy, hypertension, rectal prolapse, acute pancreatitis, sickle cell crisis, colon cancer, systemic lupus erythematosus, amyloidosis, anticardiolipin antibody syn- drome, Buerger s disease, and Kawasaki syndrome [11][12][13] . Other case reports have described associations between the development of ischemic colitis and the use of some agents such as progesterone, ergotamine derivatives, nonsteroidal anti-in ammatory drugs, and danazol 14 , intravenous vasopressin therapy 15 , renal transplantation 16 , chronic intermittent peritoneal dialysis 17 , cocaine abuse, snake bite, and marathon running 11 . Clinical presentation is usually acute, with abrupt onset of cramping abdominal pain, abdominal distension, and bloody diarrhea.…”

Section: Discussionmentioning

confidence: 99%

A Case of Ischemic Colonic Stenosis of the Splenic Flexure

Umemoto

Yokomizo

Shimada

et al. 2011

Showa Univ J Med Sci

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: Ischemic colitis is characterized by lesions arising from colonic ischemia. The treatment of choice is surgery, and resection of the affected segment is often life saving. This study presents a case of segmental ischemic colonic stenosis of the splenic flexure. A 70-year-old woman was admitted to our hospital with abdominal pain and distension. Physical examination revealed mild tenderness of the left-upper abdomen but no peritoneal signs. A computed tomography scan demonstrated a thickening of the splenic exure of the colon with active in ammation. A gastrogra n enema revealed a 5-cmlong tight stricture at the left transverse colon, which suggested a subileus. Surgery for segmental ischemic colonic stenosis was performed because the stricture did not respond to treatment. Pathological examination revealed features typical of ischemic colitis, including ulceration and segmental colonic stenosis of the splenic exure, but revealed no evidence of tumors, lymph node swelling, or vascular disorder.

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Ischemic Colitis in Chronic Intermittent Peritoneal Dialysis

Cited by 18 publications

References 6 publications

Non-Occlusive Mesenteric Ischemia in Chronically Dialyzed Patients: A Disease with Multiple Risk Factors

Non-Occlusive Mesenteric Ischemia in Chronically Dialyzed Patients: A Disease with Multiple Risk Factors

An Important Differential Diagnosis in Capd Patients with Sudden Onset of Fever, Vomiting, Abdominal Pain, and Cloudy Dialysate

A Case of Ischemic Colonic Stenosis of the Splenic Flexure

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