Management of Ischemic Colitis

Washington, Christopher; Carmichael, Joseph C.

doi:10.1055/s-0032-1329534

Cited by 111 publications

(145 citation statements)

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“…Clinical examination often reveals just abdominal tenderness. Peritoneal signs correspond to more advanced disease like transmural necrosis and it should be always kept in mind that systemic signs of SIRS (Systemic Inflammatory Response Syndrome) may develop [3,4]. Plain abdominal radiographs are generally insensitive and they often show generalized bowel distension and air-filled bowel loops as in our patient.…”

Section: Discussionmentioning

confidence: 51%

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Ischemic Colitis after Hemorrhagic Shock Due to Obstetrical Reasons

Kasap¹

2015

CSMC

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IntroductıonIschemic colitis is the most common form of ischemic injury of the gastrointestinal tract and arises from occlusion, vasospasm, and/or hypoperfusion of the mesenteric vessels [1]. In this case, a patient who suffered from ischemic colitis due to acute postpartum hemorrhage after cesarean section was presented. *Corresponding author: Case PresentationA 28-year-old, gravid-2 para-2 women was diagnosed with preeclampsia and abruption of placenta at 30 weeks of gestation had been operated in emergency conditions at another hospital. Developing postpartum hemorrhage, firstly she was treated by conservative methods then transferred to our clinic in five hours. On the first examination, the patient was pale and hypotensive. Her pulse was weak and tachycardic.Blood was oozing from the pfanenstiel's incision and there was 1500 ml of blood in the abdominal drain. Initial blood tests showed hemoglobin to be 6.1 g/dl, leukocytes 11.200/mm 3 , platelets 58.500/mm 3 , INR 1.23, D-dimer >4000 ng/mL, aspartate transaminase 62 U/mL, calcium 7.2 mg/dL, and fibrinogen 166.8 mg/dL. She had coagulation failure and shock.Emergent laparotomy was performed since the patient did not respond to bimanual uterine massage and uterotonic medication. At laparotomy we found of 2L hemoperitoneum. Uterine atony responded poorly to conventional uterotonics, bimanual uterine massage and also uterine artery ligation and internal iliac artery ligation. When the B-Lynch suture also failed to control bleeding, we proceeded to hysterectomy. On the postoperative first day, she developed hypertension and tachycardia (blood pressure was 230/135 mmHg; heart rate range 136 bpm and was treated with Esmolol Hydrochloride, Amlodipine, Furosemide and Sodium Nitroprusside. Ceftriaxon 2 g/day was administered. She had passage of flatus on postoperative day 2 and 3 then stabilized on postoperative day 4.On the fifth postoperative day, the patient complained of nausea, vomiting, abdominal pain and distension. Her bowel sounds were hypoactive and urine output was decreased. Her condition continued to deteriorate, and she developed acute renal failure, pyrexia (38.4°C) and increasing distension of the abdomen rapidly. Antibiotherapy was changed as Meropenem (1000 mg 3 x 1) and Teicoplanin (400 mg 1 x 1).Abdominal examination revealed mild to moderate tenderness. In the plain abdominal radiograph, the colon was filled with gas, and the ascending colon's diameter was increased to 96 mm (Figure 1). Air-fluid levels were present in the dilated bowel loops on upright radiographs. Computed Tomography (CT) imaging showed widespread colonic dilatation (Figure 2). Her laboratory values were as follows; white blood count, 30.600/μl; hemoglobin, 10.6 g/dl; platelets, 202.000/μl. As intestinal perforation could not be excluded, a laparotomy was performed.At laparotomy, the whole colon, especially the ascending colon was found to be greatly distended as well as pale and ischemic. There was no evidence of mechanical obstruction, perforation or peritonitis. A rectal tu...

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Section: Discussionmentioning

confidence: 51%

“…Other usual symptoms are diarrhea and/or hematochezia (68%), abdominal distention (63%), and nausea/vomiting (38%) [3,4]. Clinical examination often reveals just abdominal tenderness.…”

Section: Discussionmentioning

confidence: 99%

Ischemic Colitis after Hemorrhagic Shock Due to Obstetrical Reasons

Kasap¹

2015

CSMC

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“…Despite advances in surgery, antimicrobial therapies, and postoperative intensive care, emergency colonic surgery remains a high-risk procedure, especially in elderly patients with morbidity and mortality rates of 11-35 and 9-22%, respectively; age, comorbidities, and American Society of Anesthesiologists (ASA) score, among others, have been reported as significant risk factors. The appropriate surgical approach for colonic emergencies is difficult to determine given the various etiologies of colonic disease [1,2,3,4,5]; the debate continues to evolve despite the recent shift toward one-stage treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

Changes in the Surgical Approach to Colonic Emergencies during a 15-Year Period

Costa¹,

Torre²,

Frezza³

et al. 2014

Dig Surg

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Purpose: The present study aims to determine the morbidity and mortality of emergency colonic surgery and the factors associated with adverse outcome, and to evaluate any change in incidence of the different types of pathological conditions and in the surgical approach over the last 15 years. Materials and Methods: A total of 319 patients who underwent emergency colonic surgery between January 1997 and December 2011 were retrospectively analyzed. Patients were divided into two groups according to the date of surgery, namely group 1, between 1997 and 2006, and group 2, between 2006 and 2011. The differences in terms of postoperative outcomes between the groups were analyzed. Results: Overall postoperative morbidity and mortality rates were 25.3 and 17.2%, respectively; no differences were found between the groups. Group 2 showed a significantly increased rate of primary resection and anastomosis (p < 0.001), as well as an increase in laparoscopic approach compared with group 1 (p < 0.001). Conclusions: Emergency colon surgery is today primarily performed for benign diseases, of these the most common is diverticular disease followed by ischemic colitis. Age, comorbidities, and ischemic colon disease are predictors of adverse outcomes, while the surgical procedure per se is not.

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“…It is also a diagnosis of exclusion with no identified cause [10,11]. The age-and sex-adjusted incidence rate was estimated to be 22.9 per 100,000 patient-years (PYs) (95 % confidence interval [CI] 18.6-27.3) for the period 2006-2009 among unselected subjects in a US county [12].…”

mentioning

confidence: 99%

“…The age-and sex-adjusted incidence rate was estimated to be 22.9 per 100,000 patient-years (PYs) (95 % confidence interval [CI] 18.6-27.3) for the period 2006-2009 among unselected subjects in a US county [12]. The incidence was twice as frequent for women and increased strongly with age, from 1.1 per 100,000 PYs before the age of 40 years to 107 per 100,000 PYs for subjects aged 80 years or older [10]. In this study, the main risk factor was a hypotensive episode in the previous month (odds ratio [OR] 33.0, 95 % CI 13.3-80.9) [11].…”

mentioning

confidence: 99%

Antihypertensive Drugs, Hypotension, and Ischemic Colitis

Blin

2015

Am J Cardiovasc Drugs

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Management of Ischemic Colitis

Cited by 111 publications

References 58 publications

Ischemic Colitis after Hemorrhagic Shock Due to Obstetrical Reasons

Ischemic Colitis after Hemorrhagic Shock Due to Obstetrical Reasons

Changes in the Surgical Approach to Colonic Emergencies during a 15-Year Period

Antihypertensive Drugs, Hypotension, and Ischemic Colitis

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