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Predictors of severity in ischaemic colitis
International Journal of Colorectal Disease, 08/23/2011
Clinical Article
O’Neill S et al. – The majority of patients with ischaemic colitis(IC) can be managed conservatively. Right–sided IC, guarding, lack of bleeding per rectum and chronic constipation are associated with severe IC.
Methods- Retrospective study of consecutive patients admitted with a robust diagnosis of IC over a 5–year period was performed.
- As IC is often misdiagnosed, strict inclusion criteria including supporting histopathology, exclusion of inflammatory bowel disease, absence of recent antibiotics or negative stool sampling with testing for Clostridium difficile were adhered to.
- Due to differing pathophysiology involved, patients suffering IC due to injury to colonic perfusion from vascular procedures or tumours were also excluded.
- Patients were divided by outcomes into a severe IC group including those that needed surgery or suffered mortality and a non–severe IC group that included patients managed medically with good evolution during their index admission.
- Patient characteristics were analysed to identify statistically significant predictors of severity (p<0.05).
- 32 patients (11 males, 21 females; mean age 72.5) met the inclusion criteria.
- Medical management was adopted in 23 patients with a single mortality (4.3%).
- Nine patients were managed surgically with two mortalities (22.2%), giving an overall mortality of 9.4% and a severe IC group consisting of ten patients.
- Significant prognostic predictors of severity included: right–sided IC (p=0.0002), guarding (p=0.001), lack of bleeding per rectum (p=0.005) and chronic constipation (p=0.02).