Clinical characteristics of idiopathic mesenteric phlebosclerosis / 中华老年医学杂志

Objective:To analyze and summarize the clinical manifestations, imaging and colonoscopy characteristics, treatment and prognosis of idiopathic mesenteric phlebosclerosis(IMP), so as to raise clinicians' awareness of this rare disease.Methods:One case of IMP admitted into the Department of Gastroenterology, Beijing Hospital, was reported.The patient was admitted primarily due to abdominal pain, distension, and obstructed defecation and flatulence for 3 months, and recurrent vomiting for 2 days.Combining the patient's medical history, symptoms, physical signs, imaging and colonoscopy results, IMP was suspected to be the most likely cause for incomplete intestinal obstruction in this case.The literatures on IMP published before April 2021, including case reports, reviews and articles, were collected and analyzed.Based upon information mentioned above, the epidemiological characteristics, pathogenesis, clinical manifestations, diagnosis, treatment and prognosis of IMP were systematically reviewed.Results:A total of 206 cases of idiopathic mesenteric vein sclerosing enteritis had been reported up to April 2021 in the literature, with a male to female ratio of about 2.75∶1.Age was clearly mentioned in 111 case reports, with a median age of 59 years and 36 patients(32.4%)≥65 years old.Common clinical manifestations include abdominal pain, distension, diarrhea, hematochezia, nausea and vomiting, obstructed defecation and flatulence, among others.The lesion is usually at the right side of the colon, including the cecum, ascending colon and transverse colon, with the ascending colon as the most commonly involved site.Imaging characteristics include linear, serrated or tortuous calcification of vessels inside the involved colon segments and adjacent mesenterium, edema and thickening of the intestinal wall, and reactive hyperplasia of lymph nodes, etc.Endoscopic features include edema and thickening of the intestinal wall, discoloration of the mucosa, and tortuous and dilated submucosal vessels.Complications include intestinal obstruction, perforation and necrosis.In most cases, symptoms subside after patients stop taking herbal medicines and go through conservative treatment for microcirculation improvement, anti-inflammation, anti-coagulation, anti-infection, etc.Overall, the prognosis of IMP is satisfactory.Conclusions:IMP is a type of non-obstructive, non-thrombotic and non-inflammatory mesenteric phlebosclerosis that causes intestinal ischemia.The pathogenesis of the disease is still unclear.Combination of characteristic clinical manifestations, imaging especially CT findings, endoscopic and histopathological examinations will help the diagnosis of IMP.

Colitis isquémica y neumatosis intestinal en paciente con COVID-19: reporte de caso / Ischemic colitis and pneumatosis intestinalis in a patient with COVID-19: a case report

RESUMEN El coronavirus tipo 2 del síndrome respiratorio agudo grave (SARS-CoV-2) es el virus causante de la pandemia actual. En general, los pacientes infectados con SARS-CoV-2 desarrollan enfermedades respiratorias. Los síntomas iniciales son fiebre, tos y disnea que progresan con rapidez a una neumonía; además, se han reportado afectaciones extrapulmonares como las gastrointestinales. Está descrito que el receptor de la enzima convertidora de angiotensina 2 (ACE2) y la serina proteasa TMPRSS2 para cebado de la proteína S facilitan el ingreso del SARS-CoV-2 a las células. Estas proteínas se expresan en células alveolares tipo 2 y también en los enterocitos del íleon y colon, por lo que se ha detectado el virus en el tracto digestivo (1). Presentamos el caso de un paciente con neumonía por COVID-19, que también presentó neumatosis intestinal y colitis isquémica, ambas manifestaciones gastrointestinales.

ABSTRACT The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus causing the ongoing pandemic. In general, patients infected with SARS-CoV-2 develop respiratory diseases. The first symptoms are fever, cough and dyspnea that rapidly progress to pneumonia. Additionally, extrapulmonary manifestations, such as those in the gastrointestinal system, have been reported. It has been described that the angiotensin-converting enzyme 2 (ACE2) receptor and the transmembrane serine protease 2 (TMPRSS2) for S protein priming favor SARS-CoV-2 entry into the cells. These proteins are expressed in alveolar type II cells as well as in ileum and colon enterocytes, thus detecting the virus in the digestive tract. We present the case of a patient with COVID-19 pneumonia and gastrointestinal findings such as pneumatosis intestinalis and ischemic colitis.

Differentiation between stercoral perforation and colorectal cancer perforation

SUMMARY OBJECTIVE: To determine the computed tomography (CT) signs associated with stercoral perforation and colorectal cancer perforation. MATERIALS AND METHODS: From May 2003 to Feb. 2015, all surgically and pathologically confirmed patients with stercoral perforation (n=8, mean age 68.3 years) or colon cancer perforation (n=11, mean age 66.3 years) were retrospectively reviewed by two board-certified radiologists blinded to the proven diagnosis. The following CT findings were evaluated and recorded for each patient: wall thickness of the distal colon adjacent to perforation site, pattern of the colon wall thickening and enhancement, length of the thickened bowel wall, presence of fecaloma, degree of proximal colon dilatation, and pericolonic inflammation or presence of pericolonic abscess, and number of enlarged pericolonic lymph nodes. These findings were correlated with the pathologic diagnosis. RESULTS: The mean thickness of the distal colonic wall adjacent to the perforation site was 13.6 mm in patients with colorectal cancer perforation and 5.1 mm with stercoral perforation, which was statistically different. There was a significant correlation between colorectal cancer perforation and eccentric wall thickening (p<0.01). CT findings of layered enhancing wall thickening (p<0.01) and the presence of fecaloma in the proximal colon (p<0.01) were significant findings for stercoral perforation. Patients with colorectal cancer displayed more pericolonic lymph nodes (mean 2.27, p<0.05). CONCLUSION: Fecaloma in the proximal colon and layered enhancing wall thickening adjacent to perforation site are likely due to stercoral perforation. Eccentric bowel wall thickening at the distal portion of the perforation site with many enlarged pericolonic lymph nodes is most likely due to colorectal cancer perforation.

RESUMO OBJETIVO: Determinar os sinais de CT associados à perfuração estercoral e perfuração do câncer colorretal. MÉTODOS: De maio de 2003 a fevereiro de 2015, todos os pacientes cirurgicamente e patologicamente confirmados com perfuração estercoral (n = 8, idade média de 68,3 anos) ou perfuração de câncer de cólon (n = 11, idade média de 66,3 anos) foram revisados retrospectivamente por dois radiologistas certificados por placa cegados ao diagnóstico comprovado. Os seguintes achados CT foram avaliados e gravados para cada paciente: espessura da parede do cólon distal adjacente ao local da perfuração, padrão de espessamento e realce da parede do cólon, comprimento da parede intestinal espessada, presença de fecaloma, grau de dilatação do cólon proximal e inflamação pericolônica ou presença de abscesso pericolônico e número de linfonodos pericolônicos aumentados. Esses achados foram correlacionados com o diagnóstico patológico. RESULTADOS: A espessura média da parede colônica distal adjacente ao local de perfuração foi de 13,6 mm em pacientes com perfuração de câncer colorretal e 5,1 mm com perfuração estercoral, que foi estatisticamente diferente. Houve uma correlação significativa entre a perfuração do câncer colorretal e o espessamento da parede excêntrica (p < 0,01). Os achados de CT de espessamento de parede aprimorada em camadas (p < 0,01) e presença de fecaloma no cólon proximal (p < 0,01) foram achados significativos para perfuração estercoral. Os pacientes com câncer colorretal apresentaram mais linfonodos pericolônicos (média 2,27, p < 0,05). CONCLUSÃO: O fecaloma no cólon proximal e o espessamento da parede que aumenta a camada adjacente ao local da perfuração são provavelmente devidos à perfuração estereocálica. O espessamento da parede intestinal excêntrica na porção distal do local da perfuração com muitos gânglios linfáticos pericolônicos aumentados é provavelmente a perfuração do câncer colorretal.

Analysis of high risk factors and clinical characteristics of 48 cases with ischemic colonic disease / 中国基层医药

Objective To investigate the clinical manifestations ,endoscopy,pathological features and highrisk factors of ischemic colitis ( IC).Methods The clinical data of 48 inpatients with IC in the Traditional Chinese Medicine Hospital of Yuhuan from January 2016 to December 2017 were analyzed retrospectively.The risk factors of IC were analyzed by logistic regression.Results IC patients had chronic diseases such as hypertension,hyperlipidemia and diabetes.Clinical symptoms included abdominal pain and bloody stool.Colonoscopy showed that the lesions of colonic mucosa were distributed regionally ,manifested as edema,hemorrhage,erosion and pleomorphic ulcer.In severe cases, stenosis of the lumen could be seen.Pathological findings included necrosis,mucosal edema,hemorrhage,ulcer formation, submucosal hemorrhage and inflammatory cell infiltration.Laboratory examination:leukocyte,serum apolipoprotein B, serum fibrinogen,neutrophil,D－dimer,serum TG and TC were higher than normal levels.Logistic regression results showed that hypertension (OR＝4.03,P＝0.014),diabetes(OR＝2.61,P＝0.020),high triglyceride ( OR＝3.21, P＝0.022),atrial fibrillation and other factors (OR＝2.50,P＝0.017) were closely related to the incidence of IC. Conclusion The symptoms of IC are not typical.Early diagnosis should be made by colonoscopy.Hypertension, diabetes,hyperlipidemia and atrial fibrillation are risk factors of IC.

CTA observation on relationship of right collateral ischemic colitis and calcified plaque of superior mesenteric artery / 中国医学影像技术

Objective: To explore the relationship of right collateral ischemic colitis (IC) and calcified plaque of superior mesenteric artery (SMA). Methods Totally 605 patients who underwent CTA of SMA were enrolled and analyzed retrospectively, including 81 patients in IC group and 524 patients in the non-IC group. The detection rate of SMA calcified plaque was compared between the 2 groups. The number, morphology and location of SMA calcified plaque, as well as the degree of stenosis of the opening and the narrowest part of SMA in IC group and the non-IC group were analyzed and compared, and the ROC curve was used to evaluate the efficacy of SMA stenosis degree in diagnosis of IC. Results The incidence of SMA calcified plaques in IC group (13/81, 16.05%) was higher than that in non-IC group (33/524, 6.30%; P=0.002). The number of SMA calcified plaques in IC group was more than that in the non-IC group (P=0.043). Significant difference in the location of calcified plaque was found between the 2 groups (P<0.001). SMA calcified plaques mostly located in the distal segment in IC group, while in the proximal or middle segment in non-IC group. There was no significant difference of plaque morphology between the 2 groups (P=0.421). Statistically significant difference of the narrowest stenosis degree was detected between the 2 groups (P<0.001). The AUC of the narrowest stenosis degree in diagnosis of IC was 0.838 (P<0.001), the sensitivity was 76.92% (10/13), and the specificity was 87.88% (29/33). Conclusion When there are more calcified plaques located in the distal segment of SMA and stenosis degree of the narrowest segment of SMA ≥25%, IC should be considered.

Screening of serological markers for differential diagnosis ischemic colitis and ulcerative colitis by proteomic techniques / 中华消化杂志

Objective To screen and identify serum protein biomarkers for the differential diagnosis between ischemic colitis (IC) and ulcerative colitis (UC) by tandem mass tag (TMT) combined with liquid chromatography/tandem mass spectrometry (LC-MS/MS).Methods From January 2018 to January 2019,at the First Affiliated Hospital of School of Medicine of Zhejiang University,patients with UC or IC,and health controls,each l0 cases,were enrolled into UC group,IC group and normal control (NC) group,respectively.Fasting serum samples of all the subjects were collected.After removal of high-abundance protein,followed by proteolysis,peptide labeling and fractionating,the samples were then processed by mass spectrometry.The protein with TMT data of three groups was obtained and protein with TMT value 0 were removed.Heat map of protein was constructed.The differential protein was defined as the protein fold change over 1.5 or less than 0.67.The Reactome database was used to cluster the pathways of differential proteins among groups.Statistical methods included t test,hypergeometry test and corrected by BH multiple test.Results A total of 357 serum proteins were identified by proteomic profiling.There were 27 differential proteins between the IC group and the NC group,including six up-regulated proteins and 21 down-regulated proteins.There were 228 differential proteins between the UC group and the NC group,including 75 up-regulated proteins and 153 down-regulated proteins.There were 49 differential proteins between UC group and IC group,including 22 up-regulated proteins and 27 down-regulated proteins.In the comparison of differential proteins between the NC group,IC group and UC group,only the expression of fibrin 3 was statistically significant (the fold change between UC and NC,between UC and IC,between IC and NC were 0.24,0.46 and 0.53,respectively;t =-5.089,-7.298 and -3.919,all P ＜ 0.01).The results of pathway cluster analysis showed that in the comparison of differential proteins between IC group and NC group,only the platelet degranulation pathway was enriched,and 10 proteins were involved in this pathway (P ＜ 0.01).In the comparison of differential proteins between UC group and NC group,there were 58 pathways enriched,of which 38 proteins were involved in the platelet degranulation pathway,16 proteins were involved in the initial complement trigger pathway,13 proteins were involved in the complement cascade pathway,and 11 proteins were involved in antibody-mediated complement activation pathway (all P ＜ 0.01).In the comparison of differential proteins between UC group and IC group,three different pathways were obtained.Among them,nine proteins were involved in the platelet degranulation pathway,seven proteins were involved in the initial complement trigger pathway,and five proteins were involved in the complement cascade pathway (all P ＜ 0.01).Conclusions The difference in serum proteome between IC patients and UC patients was significant,and the differential proteins are mainly involved in platelet activation and complement activation.The candidate proteins identified in this study may be used as biomarkers for the differential diagnosis of UC and IC in the future.

Analysis of high risk factors and clinical characteristics of 48 cases with ischemic colonic disease / 中国基层医药

Objective@#To investigate the clinical manifestations, endoscopy, pathological features and highrisk factors of ischemic colitis(IC).@*Methods@#The clinical data of 48 inpatients with IC in the Traditional Chinese Medicine Hospital of Yuhuan from January 2016 to December 2017 were analyzed retrospectively.The risk factors of IC were analyzed by logistic regression.@*Results@#IC patients had chronic diseases such as hypertension, hyperlipidemia and diabetes.Clinical symptoms included abdominal pain and bloody stool.Colonoscopy showed that the lesions of colonic mucosa were distributed regionally, manifested as edema, hemorrhage, erosion and pleomorphic ulcer.In severe cases, stenosis of the lumen could be seen.Pathological findings included necrosis, mucosal edema, hemorrhage, ulcer formation, submucosal hemorrhage and inflammatory cell infiltration.Laboratory examination: leukocyte, serum apolipoprotein B, serum fibrinogen, neutrophil, D-dimer, serum TG and TC were higher than normal levels.Logistic regression results showed that hypertension(OR=4.03, P=0.014), diabetes(OR=2.61, P=0.020), high triglyceride (OR=3.21, P=0.022), atrial fibrillation and other factors(OR=2.50, P=0.017) were closely related to the incidence of IC.@*Conclusion@#The symptoms of IC are not typical.Early diagnosis should be made by colonoscopy.Hypertension, diabetes, hyperlipidemia and atrial fibrillation are risk factors of IC.

Screening of serological markers for differential diagnosis ischemic colitis and ulcerative colitis by proteomic techniques / 中华消化杂志

Objective@#To screen and identify serum protein biomarkers for the differential diagnosis between ischemic colitis (IC) and ulcerative colitis (UC) by tandem mass tag (TMT) combined with liquid chromatography/tandem mass spectrometry (LC-MS/MS).@*Methods@#From January 2018 to January 2019, at the First Affiliated Hospital of School of Medicine of Zhejiang University, patients with UC or IC, and health controls, each 10 cases, were enrolled into UC group, IC group and normal control (NC) group, respectively. Fasting serum samples of all the subjects were collected. After removal of high-abundance protein, followed by proteolysis, peptide labeling and fractionating, the samples were then processed by mass spectrometry. The protein with TMT data of three groups was obtained and protein with TMT value 0 were removed. Heat map of protein was constructed. The differential protein was defined as the protein fold change over 1.5 or less than 0.67. The Reactome database was used to cluster the pathways of differential proteins among groups. Statistical methods included t test, hypergeometry test and corrected by BH multiple test.@*Results@#A total of 357 serum proteins were identified by proteomic profiling. There were 27 differential proteins between the IC group and the NC group, including six up-regulated proteins and 21 down-regulated proteins. There were 228 differential proteins between the UC group and the NC group, including 75 up-regulated proteins and 153 down-regulated proteins. There were 49 differential proteins between UC group and IC group, including 22 up-regulated proteins and 27 down-regulated proteins. In the comparison of differential proteins between the NC group, IC group and UC group, only the expression of fibrin 3 was statistically significant (the fold change between UC and NC, between UC and IC, between IC and NC were 0.24, 0.46 and 0.53, respectively; t=-5.089, -7.298 and -3.919, all P<0.01). The results of pathway cluster analysis showed that in the comparison of differential proteins between IC group and NC group, only the platelet degranulation pathway was enriched, and 10 proteins were involved in this pathway (P<0.01). In the comparison of differential proteins between UC group and NC group, there were 58 pathways enriched, of which 38 proteins were involved in the platelet degranulation pathway, 16 proteins were involved in the initial complement trigger pathway, 13 proteins were involved in the complement cascade pathway, and 11 proteins were involved in antibody-mediated complement activation pathway (all P<0.01). In the comparison of differential proteins between UC group and IC group, three different pathways were obtained. Among them, nine proteins were involved in the platelet degranulation pathway, seven proteins were involved in the initial complement trigger pathway, and five proteins were involved in the complement cascade pathway (all P<0.01).@*Conclusions@#The difference in serum proteome between IC patients and UC patients was significant, and the differential proteins are mainly involved in platelet activation and complement activation. The candidate proteins identified in this study may be used as biomarkers for the differential diagnosis of UC and IC in the future.

Ischemic Colitis Associated with Rhabdomyolysis and Heat Stroke after an Intense Exercise in Young Adult / 대한소화기학회지

Ischemic colitis primarily affects the elderly with underlying disease, but it rarely occurs in young adults with risk factors, such as coagulopathy or vascular disorder. Moreover, it is extremely rare in the very young without risk factors. This paper presents a patient with ischemic colitis associated with heat stroke and rhabdomyolysis after intense exercise under high-temperature conditions. A 20-year-old man presented with mental deterioration after a vigorous soccer game for more than 30 minutes in sweltering weather. He also presented with hematochezia with abdominal pain. The laboratory tests revealed the following: AST 515 U/L, ALT 269 U/L, creatine kinase 23,181 U/L, BUN 29.1 mg/dL, creatinine 1.55 mg/dL, and red blood cell >50/high-power field in urine analysis. Sigmoidoscopy showed ischemic changes at the rectum and rectosigmoid junction. A diagnosis of ischemic colitis and rhabdomyolysis was made, and the patient recovered after conservative and fluid therapy. This case showed that a diagnosis of ischemic colitis should be considered in patients who present with abdominal pain and bloody diarrhea after intense exercise, and appropriate treatment should be initiated immediately.

Rectal Ulcer Developed in Systemic Lupus Erythematosus without Ischemic Colitis / 대한소화기학회지

Rectal involvement by systemic lupus erythematosus (SLE) is quite rare. Approximately 14 cases have been reported worldwide, but only one with ischemic colitis has been reported in Korea. A 17-year-old female patient was hospitalized with abdominal pain and hematochezia. Sigmoidoscopy revealed only a simple rectal ulcer without ischemic colitis. cytomegalovirus and bacterial infections were excluded. A sigmoidoscopic rectal biopsy indicated a rectal invasion by SLE, but the patient showed an acute worsening conditions that did not respond to treatment. This paper reports a case of rectal ulcer that developed in SLE without ischemic colitis with a review of the relevant literature.

Ischemic Colitis Associated with Rhabdomyolysis and Heat Stroke after an Intense Exercise in Young Adult / 대한소화기학회지

Ischemic colitis primarily affects the elderly with underlying disease, but it rarely occurs in young adults with risk factors, such as coagulopathy or vascular disorder. Moreover, it is extremely rare in the very young without risk factors. This paper presents a patient with ischemic colitis associated with heat stroke and rhabdomyolysis after intense exercise under high-temperature conditions. A 20-year-old man presented with mental deterioration after a vigorous soccer game for more than 30 minutes in sweltering weather. He also presented with hematochezia with abdominal pain. The laboratory tests revealed the following: AST 515 U/L, ALT 269 U/L, creatine kinase 23,181 U/L, BUN 29.1 mg/dL, creatinine 1.55 mg/dL, and red blood cell >50/high-power field in urine analysis. Sigmoidoscopy showed ischemic changes at the rectum and rectosigmoid junction. A diagnosis of ischemic colitis and rhabdomyolysis was made, and the patient recovered after conservative and fluid therapy. This case showed that a diagnosis of ischemic colitis should be considered in patients who present with abdominal pain and bloody diarrhea after intense exercise, and appropriate treatment should be initiated immediately.

Rectal Ulcer Developed in Systemic Lupus Erythematosus without Ischemic Colitis / 대한소화기학회지

Rectal involvement by systemic lupus erythematosus (SLE) is quite rare. Approximately 14 cases have been reported worldwide, but only one with ischemic colitis has been reported in Korea. A 17-year-old female patient was hospitalized with abdominal pain and hematochezia. Sigmoidoscopy revealed only a simple rectal ulcer without ischemic colitis. cytomegalovirus and bacterial infections were excluded. A sigmoidoscopic rectal biopsy indicated a rectal invasion by SLE, but the patient showed an acute worsening conditions that did not respond to treatment. This paper reports a case of rectal ulcer that developed in SLE without ischemic colitis with a review of the relevant literature.

Clinical Features and Management of Ischemic Colitis in Elderly Patients / 胃肠病学

Ischemic colitis (IC)is one of the major causes of acute lower gastrointestinal bleeding and usually occurs in the elderly. Hypoperfusion of the mesenteric microvasculature,even induced by constipation in the elderly,is by far the approximate mechanism. The clinical manifestations of IC vary depending on the extent and duration of ischemia. The presenting symptoms include sudden cramping abdominal pain;an urgent desire to defecate;and passage within 24 hours of bright red or maroon blood or bloody diarrhea. CT scan should be the first imaging modality of choice for patients with suspected IC to assess the distribution and phase of colitis. Early colonoscopy (within 48 hours of presentation)should be performed to confirm the diagnosis if without gangrene and perforation. Nonsurgical treatment approach usually includes bowel rest,intravenous fluid,electrolyte repletion,correction of precipitating conditions and antibiotic usage,occasionally with administration of total parenteral nutrition. It has been shown that isolated right colonic ischemia (IRCI)has a worse outcome than ischemia affecting other regions of the colon. Surgical intervention should be considered in the presence of IRCI or pan-colonic ischemia and in the presence of gangrene.

Bevacizumab-associated Ischemic Colitis Proven by Colonoscopy / 대한내과학회지

Bevacizumab is a monoclonal antibody against vascular endothelial growth factor widely used to treat several types of solid tumor. Although bevacizumab has fewer adverse effects than conventional chemotherapy agents, several serious events have been reported. Gastrointestinal perforation is an infrequent but potentially fatal side-effect of bevacizumab. The major mechanism of bevacizumab-associated gastrointestinal perforation is damage to the intestinal vasculature. However, preceding ischemic colitis is difficult to diagnose due to its non-specific symptoms. We report a case of a 56-year-old male with bevacizumab-associated ischemic colitis proven by colonoscopy and pathologic findings. The patient's condition improved after general supportive care including bowel rest, intravenous fluids, and intravenous antibiotics. No similar event has been reported since he resumed chemotherapy without bevacizumab.

Uso de complejo de protrombina ensangrado digestivo bajo en el paciente crítico anticoagulado. reporte de caso / Use of prothrombin complex concentrate in lower gastrointestinal bleeding in a critical anticoagulated patient. a case report

Se presenta el caso de un varón de 66 años en post-operatorio de cirugía de Bentall y reemplazo de válvula aórticapor prótesis metálica, anticoagulación con warfarina, que presenta un episodio de sangrado digestivo bajo secundarioa colitis isquémica localizada con INR elevado, sufriendo descompensación hemodinámica. Se realizó tratamientocon concentrado de protrombina humana con adecuada respuesta.

We present the case of a 60-year-old male patient anticoagulated with warfarin who presented with lowergastrointestinal bleeding and hemodynamic instability due to ischemic colitis with high INR after being surgicallyintervened with Bentall´s procedure and aortic valve replacement with a metallic prosthesis. Treatment withprothrombin complex concentrate was started with good response.

Severe Ischemic Colitis from Gastric Ulcer Bleeding-Induced Shock in Patient with End Stage Renal Disease Receiving Hemodialysis

Upper gastrointestinal bleeding is a common condition and has various clinical courses and prognosis. End stage renal disease (ESRD) patients receiving hemodialysis have a high risk of vascular complications and increased risk of ischemic colitis. A 59-year-old male patient with ESRD receiving hemodialysis visited due to hematemesis. After admission, he showed recurrent hematemesis and hypovolemic shock. Upper esophagogastroduodenoscopy revealed gastric ulcer bleeding and endoscopic hemostasis was successfully performed. Blood transfusion and norepinephrine was administered for hypovolemic shock during initial 3 days. Ten days later, he exhibited hematochezia. Sigmoidoscopy revealed necrotic ischemic colitis in sigmoid colon and segmental colectomy was performed. However, recurrent leakage and ischemia were developed in colon as well as small bowel, and he finally died after 55 hospital days in spite of additional operations. Here, we report a case of peptic ulcer bleeding in patient with ESRD who suffered a severe form of ischemic colitis with transmural necrosis.

Ischemic Colitis Caused by Terlipressin during Treatment of Hepatorenal Syndrome / 대한내과학회지

Terlipressin, a vasopressin agonist, is widely used to treat variceal bleeding and hepatorenal syndrome in patients with liver cirrhosis. Terlipressin increases systemic vascular resistance, particularly in the splanchnic area, thus decreasing portal pressure. Although terlipressin is associated with a lower incidence of severe cardiovascular complications than is vasopressin, terlipressin can induce serious ischemic complications including myocardial infarction, skin necrosis, and bowel ischemia in < 1% of patients. We report the case of a 79-year-old female with liver cirrhosis treated with terlipressin to control hepatorenal syndrome that developed into ischemic colitis. The patient improved upon cessation of terlipressin and provision of supportive care.

A comparison of clinical characteristics in elderly patients with ulcerative colitis and ischemic colitis / 中华内科杂志

Objective To analyze the discrepancy and similarities of clinical characteristics in elderly patients with ulcerative colitis (UC) and ischemic colitis (IC).Methods A total of 43 elderly patients (age≥60 yrs) with UC and 36 elderly patients with IC were enrolled from 2004 to 2015 at Peking Union Medical College Hospital.The clinical characteristics were retrospectively analyzed and compared between the two groups.Results Compared with IC group,the disease course was longer with lower incidence of cardiovascular comorbidities in UC patients (P ＜ 0.05).In UC group,more patients presented with diarrhea,mucopurulent bloody stool [39 (90.7％) vs 16 (44.4％) and 34 (79.1％) vs 2 (5.6％)respectively,both P ＜ 0.01].Yet bloody stool as the only symptom was seen in more IC patients than UC patients [61.1％ (22/36) vs 7.0％ (3/43),P ＜ 0.01].The ratio of extra-intestinal manifestations was higher [18.6％ (8/43) vs 0 (0/36)] in UC patients,while complications were lower [11.6％ (5/43) vs 30.6％ (11/36),P ＜ 0.05].As to the laboratory parameters,median platelet count [(294.38 ± 104.83) × 109/L vs (235.47±94.82) × 109/L,P ＜0.05] was higher in UC group.In addition,more patients with UC had positive perinuclear antineutrophil cytoplasmic antibody (p-ANCA) [50.0％ (15/30) vs 10.0％ (2/20),P ＜ 0.05].The most commonly involved regions of IC were descending colon and sigmoid colon,in which the lesions were clearly demarcated with the normal mucosa.Lesions in patients with UC mainly originated from rectum and might spread to the whole colon.Vascular occlusion and micro thrombosis were characteristic pathological findings of IC.The crypt abscesses were frequently seen in the UC group.Conclusion Even though UC and IC have some similar manifestations in the elderly patients,clinical and pathological discrepancy is still helpful to differentiate each other.

Clinical Characteristics of Ischemic Colitis:An Analysis of 75 Patients / 胃肠病学

Background:The incidence of ischemic colitis(IC)is increasing in recent years with the aging of population,and the rate of delayed diagnosis or misdiagnosis is high because of the lacking of specific clinical characteristics. Aims:To study the clinical characteristics of IC so as to improve its early diagnosis and treatment. Methods:The clinical and endoscopic characteristics of 75 IC patients from Jan. 2009 to Dec. 2014 at Urumqi General Hospital were retrospectively analyzed. Results:IC usually occurred in elderly patients with age ≥60 years,females were more common. Most patients had underlying diseases,including hypertension,coronary heart disease,diabetes,hyperlipidemia and arrhythmia,etc. Colonoscopy and medications could also induce IC. The main clinical presentations were abdominal pain,hematochezia and diarrhea. The lesions were mostly located in left colon and of the transient type. Conclusions:IC should be suspected when elderly patients with underlying diseases,complaining abdominal pain,hematochezia and diarrhea,colonoscopy and pathologic study should be undertaken as early as possible. Prognosis is good when treated timely.

Domestic literature survey on the epidemiology and clinical features of ischemic colitis / 中华老年医学杂志

Objective To investigate the incidence trends,clinical features and prognosis of ischemic colitis (IC) in China,and improve the level of diagnosis and treatment of IC.Methods China National Knowledge Infrastructure and VIP Chinese Science and Technology Periodical Database were searched.The ending date of search was May 15,2014.Results A total of 324 references were found,which were published from 1982 to 2013.There were 9202 cases reported,3973 cases of males and 5229 cases of females,with the male/female ratio of 1 ∶ 1.32 and mean age of (63.6±7.8)years.The amount of references and cases reported began to rise after 2002.Estimated ratio of cumulative incidence was higher in the north than in other areas of China (x2 =1097.95,P=0.000).The most common IC accompanying diseases were hypertension,heart diseases,diabetes,hyperlipidemia and constipation.There were statistically significant differences in the accompanying diseases between different regions and different times.Drugs,enteroscopy,surgery and low blood volume might be the precipitating factors.Patients commonly complained of abdominal pain,diarrhea/ desiring to defecate and hematochezia.Computed tomography was feasible in detecting lesions.Colonoscopy was the main method for diagnosis.The lesions were most common located in the left half colon including sigmoid colon,descending colon and splenic flexure,with typically in a segmental manner.Pan-colon involvement or rectum involvement rarely occurred.Type of transient lesion was the predominant subtype,which was generally managed non-operatively with good prognosis.Different from the type of transient lesion,pathological changes in gangrenous type were located in the right half colon including hepatic flexure of transverse colon,ascending colon and ileocecal junction.Gangrenous type required prompt surgical intervention but the mortality was much higher.Conclusions Incidence of CI has been increasing year by year.Patients who complain of abdominal pain,diarrhea/desiring to defecate and hematochezia should be considered as IC,particularly in the elderly women and patients with cardiovascular disease.Diseased regions are mainly located in sigmoid colon,descending colon and splenic flexure.Transient colitis is the predominant subtype,which have good prognosis.