Usefulness of colonoscopy in ischemic colitis

Abstract

Background: the ischemic colitis is intestinal the most frequent cause of ischemia. With this work we determine the demographic and clinical characteristics, and the usefulness of the colonoscopy in the patients with ischemic colitis diagnosed in our centre in relation to a change of therapeutic attitude.Method: retrospective study in which were selected 112 patients diagnosed with ischemic colitis by colonoscopy and biopsy, in a period of five years. It was analyzed: age, sex, reason for examination, factors of cardiovascular risk, endoscopic degree of ischemia, change in the therapeutic attitude, treatment and outcome.Results: the average age was of 73.64 ± 12.10 years with an equal incidence in women (50.9%) and the men (49.1%). The associated factors were the HTA (61.1%), tobacco (37.2%) and antecedents of cardiovascular episode (52.2%). The most frequent reason for colonoscopy was rectorrhagia (53.6%) followed of the abdominal pain (30.4%), being urgent the 65.3%. Colonoscopy allowed a change in the therapeutic attitude in the 50 increasing in the urgent one to the 65.75%. Global mortality was of 27.67%. The serious ischemic colitis (25%) was more frequent in men (64.3%) in urgent indication (85.71%) and attends with high mortality (53.57%). Surgical treatment in the 57.14% was made with a good evolution in the 50%, whereas the patients with mild or moderate ischemic colitis had a better prognosis (favourable evolution in 80.95%) with smaller requirement of the surgical treatment (4.76%), p < 0.05.Conclusion: the colitis ischemic are more frequent in the older age. The most frequent symptoms are the rectorrhagia and the abdominal pain. The colonoscopy is a useful technique to evaluate the gravity and it induces a change of attitude according to the result of the same one. The evidence of a serious colitis supposed an increase of the necessity of surgery and worse prognosis.

Ischemic colitis associated with hormonal contraceptive treatment delivered via vaginal ring

“…In general, the patients are diagnosed by colonoscopy, which shows a segmental involvement of the left colon (2,8). This location of the lesions is due to the lack of collaterals in that area of the colon.…”

Ischemic colitis due to vigorous physical exercise

“…Ischemic colitis is a common pathology in the general population but it rarely appears in people under 60 years old and it is extremely rare in patients so young as our patient, even more in the absence of documented risk factors (9). Vigorous physical exercise is a stressful situation to the gastrointestinal tract.…”

“…Gastrointestinal suffering is higher when physical exercise is practiced in hot days, without previous training and with a poor hydration (2). The pathophysiology of these lesions remains unclear, although most authors have related it with: ischemic tissue because of the redistribution of blood flow from the splanchnic territory to other organs during exercise (muscle, heart, lungs and brain) (6); vascular anatomic abnormalities in colon, since 30% of general population has hypoplasia of some arterial arcades or they even do not exist, which makes some regions of the colon especially vulnerable to ischemia (7); mechanical factors due to abdominal wall vibration (7,8); neuroendocrine factors related with secretion of peptids that have influence on gastrointestinal homeostasis (8,9).…”

Quelles sont les « vraies » urgences endoscopiques en pathologie colique (hors hémorragie) ?

“…L'évaluation endoscopique de sa gravité, notamment grâce à la classification de Toursarkissian et Thompson, permet une fois sur deux de modifier son traitement, détermine dans plus de huit cas sur dix les formes sévères nécessitant une chirurgie et améliore les taux de survie [52,53].…”

“…Il existe des rectorragies chez plus de sept patients sur dix. L'épaississe-ment pariétal colique à l'imagerie n'est pas spécifique mais peut s'accompagner de signes d'insuffisance vasculaire au temps artériel lors de l'opacification[52].L'endoscopie colique est utile sur les plans diagnostique et pronostique dans la plupart des pathologies coliques aiguës mais son recours en urgence répond à des critères bien définis avec une littérature pertinente. Le tableau 3 permet un récapitulatif des situations répondant à la question des « vraies » urgences endoscopiques coliques, celles pour lesquelles vous devrez vous déplacer (Tableau 3) !…”