Scripties UMCG - Rijksuniversiteit Groningen
 
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Ischemische colitis : Retrospectieve analyse van een ziektebeeld in de Isala Klinieken te Zwolle

(2012) Dam, L.J.H. van

Background:
Ischemic colitis is the most common type of intestinal ischemia and has a wide spectrum of pathogenetic mechanisms, clinical presentations and outcomes. Recent studies indicate that right-sided ischemic colitis (RIC) has a different presentation and a worse outcome than non-right-sided ischemic colitis (NRIC). The objectives of this study were: 1) to give an impression of demography, clinical characteristics, possible causes, diagnostic findings, treatments and outcomes of ischemic colitis; 2) to analyse de differences between right-sided and non-right-sided ischemic colitis and 3) to compare these results with the results of the study earlier performed in Medisch Spectrum Twente.
Methods:
Patients that were diagnosed with ischemic colitis between January 2001 and December 2011 in the Isala Klinieken in Zwolle were retrospectively included. A PALGA- (Pathologic Anatomic Nationwide Automatic Archive) and Endosoft-search were used for patient selection. Patients were included if the endoscopic, surgical and/or pathologic findings were compatible with ischemic colitis. A distinction is made between RIC and NRIC. We recorded variables that included demography, clinical characteristics, causes, diagnostic findings, treatment and outcomes. We analysed differences between RIC and NRIC with univariate analysis. Risk factors for an unfavourable outcome (surgery and/or mortality) were identified using univariate and multivariate analysis.
Results:
307 patients were included, with a mean age of 70,8 years (range 22-93 years). 53,1% of the subjects was male. The clinical presentation included rectal bleeding (81,7%), abdominal pain (78,1%) and diarrhoea (57,9%). The median hospital stay was 8 days, 31,9% of the subjects underwent surgery and 16,0% died. 83 patients (27%) had right colon involvement and in 224 patients (73%) only the left colon was involved. Patients with RIC often had a occlusive cause of the ischemic colitis (33,7% vs. 19,2%; p=0,007). Rectal bleeding occurred more frequent with NRIC. RIC was, when corrected for confounding factors, more associated with laparotomy (AOR 8,6; p<0,001) and an unfavourable outcome (AOR 5,7; p<0,001). Independent risk factors for an unfavourable outcome were, among others, ileus (AOR 17,0; p<0,001) and peritonitis (AOR 16,1; p=0,010). Rectal bleeding was a protective factor for an unfavourable outcome (AOR 0,18; p=0,002).
Conclusion:
Ischemic colitis has a higher incidence in elderly, foremost those who have a history of vascular diseases. In general there is much diversity in presentation, causes and diagnostic findings. RIC and NRIC differ in clinical presentation, cause and clinical course. Right-sided ischemic colitis is treated more often by a laparotomy and has a higher mortality rate.





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