A Comparison of Clinical Characteristics between Medically-treated Patients and Surgically-treated Patients with Ischemic Colitis

BACKGROUND/AIMS: Ischemic colitis (IC) is usually a self-limiting disease. But, it can cause necrosis that requires urgent surgical treatment. We sought to evaluate clinical difference in IC patients between medical and surgical treatment groups, and to identify prognostic factors for adverse outcomes. METHODS: We conducted a retrospective analysis of clinical characteristics in patients with IC treated in Chonnam National University Hospital between May 2001 and April 2010. A total of 81 patients with IC were enrolled. We classified the patients into two groups-a medical treatment group and a surgical treatment group-and evaluated their clinical features, treatment outcomes and mortality. RESULTS: Absence of hematochezia, vomiting, abdominal tenderness, abdominal rebound tenderness, heart rate over 90 beats/min, systolic blood pressure less than 100 mm Hg, hyponatremia and increased LDH or serum creatinine level were observed more frequently in surgically-treated patients (p<0.05). Most cases in the medically-treated group resolved without complications (98.3%). But, about half of the cases (52.4%) of the surgically-treated group resolved and the mortality rate was 47.6%. CONCLUSIONS: In patients with ischemic colitis, several clinical factors are associated with surgical treatment. Although IC is often selflimited, our data suggests that special attention and aggressive therapy is warranted in treating these patients.

A Comparison of Clinical Characteristics between Medically-treated Patients and Surgically-treated Patients with Ischemic Colitis

BACKGROUND/AIMS: Ischemic colitis (IC) is usually a self-limiting disease. But, it can cause necrosis that requires urgent surgical treatment. We sought to evaluate clinical difference in IC patients between medical and surgical treatment groups, and to identify prognostic factors for adverse outcomes. METHODS: We conducted a retrospective analysis of clinical characteristics in patients with IC treated in Chonnam National University Hospital between May 2001 and April 2010. A total of 81 patients with IC were enrolled. We classified the patients into two groups-a medical treatment group and a surgical treatment group-and evaluated their clinical features, treatment outcomes and mortality. RESULTS: Absence of hematochezia, vomiting, abdominal tenderness, abdominal rebound tenderness, heart rate over 90 beats/min, systolic blood pressure less than 100 mm Hg, hyponatremia and increased LDH or serum creatinine level were observed more frequently in surgically-treated patients (p<0.05). Most cases in the medically-treated group resolved without complications (98.3%). But, about half of the cases (52.4%) of the surgically-treated group resolved and the mortality rate was 47.6%. CONCLUSIONS: In patients with ischemic colitis, several clinical factors are associated with surgical treatment. Although IC is often selflimited, our data suggests that special attention and aggressive therapy is warranted in treating these patients.

Colonic Stent Insertion Through a Colostomy in a Patient with Recurred Malignant Obstruction / 대한소화기내시경학회지

Colorectal self-expanding metal stents have been used for palliation or preoperative decompression as a bridge-to-surgery in patients with malignant obstruction due to primary or recurred colorectal cancer. The usual attempt to implant of the stent is through the anus under endoscopic guidance, but that is difficult or impossible in patient who have undergone laparoscopic abdominoperineal resection (APR) and who have a colostomy. Especially, to advance and position the stent in the target lesion through the colostomy is very difficult because of the tortuosity and anatomical alteration of the proximal bowel caused by surgery. We herein report on a case of recurred malignant colonic obstruction with stent placement through a preformed colostomy. To date, this approach through a colostomy for the deployment of a stent has not been described in the Korean literature.

Periampullary Gangliocytic Paraganglioma Successfully Treated by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Gangliocytic paraganglioma is a rare tumor that occurs nearly exclusively in the second portion of the duodenum. This tumor is usually considered to be benign. So, endoscopic resection may be the best procedure to facilitate the diagnosis and for treatment to avoid an unnecessary, invasive operation. To the best of our knowledge, this is the first report of a periampullary gangliocytic paraganglioma that was successfully treated by endoscopic mucosal resection in Korea. We report here a case of a 45-year-old man who was found to have a periampullary gangliocytic paraganglioma. This tumor was adequately treated by endoscopic mucosal resection.