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Gastroenterology Medicine & Research

Risk factors, Presentation, Diagnosis and Management Factors Associated with Surgery and Death in Ischemic Colitis Patients-A Retrospective Cohort Study

Submission: August 19, 2019; Published: August 26, 2019

DOI: 10.31031/GMR.2019.03.000567

ISSN 2637-7632
Volume3 Issue4

Summary

Colonic ischemia affects older patients with co-morbidities and is usually self-limited but, in certain patients, it can be fatal. It is be suspected in any patient who presents with acute abdominal pain and bloody diarrhea and is usually diagnosed on imaging.

Methods: We searched all cases of ischemic colitis based on diagnostic codes from admissions at St Joseph’s Healthcare from 2010 to 2017. The patient records were reviewed to confirm diagnosis, and clinical data collected and analyzed regarding their admission.

Results: A total of 693 patients were identified, and after exclusion, 144 were reviewed for analysis. The mean age was 70.1 years (range 27-99, SD 15), and mean length of admission was 12 days (range 0-119). Most common patient symptoms were abdominal pain (119) and hematochezia (95). Comorbidities included 73% with hypertension, 44% with dyslipidemia, 31% with coronary disease, and 27% with diabetes. A diagnostic CT was done in 93 patients (65%), and a colonoscopy in 79 (55%). Antibiotics were used in 43% of patients and blood transfusion required in 7%. Mortality was 16.6% and surgery was 15.9%. Complications of sepsis were 10.4% and acute kidney injury in 6.3%. Ris of death was associated with sepsis (p=0.004), elevated INR on presentation (p=0.02), and history of atrial fibrillation (p=0.03). Risk for surgery was significantly related with sepsis (p= 0.026).

Conclusion: Ischemic colitis was associated with a high mortality of 16.6% and high risk of surgery of 15.9%. Awareness of risk factors for poor outcome may help identify high risk patients. In our study, death was associated with patients who presented with elevated INR, past history of atrial fibrillation and those who developed sepsis.

Keywords: Ischemic colitis; Risk factors; Surgery; Mortality

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