Ischemic colitis problems of diagnosis and treatment

Abstract

Cristian Mesina, Theodor Viorel Dumitrescu, Cosmin Vasile Obleaga, Daniela Ciobanu

Objective: The aim of this study was to evaluate the characteristics of colonic ischemia and to highlight predictive factors for ischemic colitis gangrenous typeMethods: We performed a retrospective study of 20 patients with ischemic colitis, whose diagnosis was confirmed in the anatomo-pathological examination during 2010-2015. Patients with ischemic colitis were divided into two groups: severe ischemic colitis with transmural colonic ischemia and/or multi-organ failure (irreversible type – gangrenous colitis) and moderate ischemic colitis without multi-organ failure (reversible type).Results: Irreversible ischemic colitis (gangrenous ischemic type) was found in five patients. All patients with ischemic colitis gangrenous type underwent colectomy with primary anastomosis in two cases and total colectomy with ileostomy in three cases. Two patients died postoperatively (these were patients with pancolitis) because of multi-organ failure.Conclusion: The analysis of this cases indicated four factors predictive of severe ischemic colitis (gangrenous type): abdominal tenderness, absence of hematochezia, absence of diarrhea, and hypoalbuminemia. Total colectomy with ileos-tomy was the prefered surgical option.