ABSTRACT
Objective: To identify risk factors, diagnosis and prognosis associated with ischemic colitis, focusing mainly on patients undergoing surgery. Materials and methods: This retrospective study included all patients admitted to the Centro Hospitalar de São João - E. P. E., diagnosed with ischemic colitis during the period from 2012 to 2013. Results: The study included 154 patients; 118 were undergoing medical treatment, with a 12% mortality rate, and 36 were undergoing surgery, with a 61% associated mortality rate. Hypertension was the most common risk factor in both groups. The presence of a large num- ber of cardiovascular risk factors in both groups, such as hypertension and dyslipidemia, was recorded, but we still found no direct relationship with development of ischemic coli- tis. Comorbidities that affect blood flow, such as the presence of thrombi or aneurysms, do provide a worse prognosis and therefore require a more aggressive treatment. Conclusion: The diagnosis of ischemic colitis is not always immediately established due to a nonspecific presentation. Surgical treatment should be reserved for severe cases with a worse prognosis associated.
RESUMO Objetivos: Identificar fatores de risco, diagnóstico e prognóstico associados à colite isquémica, incidindo mais em doentes submetidos à cirurgia. Materiais e métodos: O estudo retrospectivo incluiu todos os doentes admitidos no Centro Hospitalar de São João-E. P. E. com diagnóstico de colite isquémica durante o período de 2012 a 2013. Resultados: O estudo incluiu 154 doentes; desses, 118 foram submetidos a tratamento médico, com uma taxa de mortalidade de 12%, e 36 foram submetidos a tratamento cirúrgico, com uma taxa de mortalidade associada de 61%. Hipertensão arterial foi o fator de risco mais comum em ambos os grupos. Foi registada a presença de grande número de fatores de risco cardiovasculares em ambos os grupos, como hipertensão arterial e dislipidemia, mas ainda não foi encontrada nenhuma relação direta com o desenvolvimento de colite isquémica. Comorbilidades que afetam o fluxo sanguíneo, como a presença de trombos ou aneurismas, fazem prever um pior prognóstico e, por isso, exigem maior agressividade no tratamento. Conclusão: O diagnóstico de colite isquémica nem sempre é imediato, devido a uma apresentação pouco específica. O tratamento cirúrgico deverá ser reservado para casos mais severos, tendo pior prognóstico associado.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Colitis, Ischemic/epidemiology , Risk Factors , Colitis, Ischemic/surgery , Colitis, Ischemic/therapy , HospitalizationABSTRACT
Severe hematochezia is a common reason for hospitalization but the causes have changed in the last decade. Changes are in part related to the aging population, the evaluation and treatment by colonoscopists rather than surgeons or non-endoscopists, and the changes in colonoscopic practices such as piecemeal polypectomy. A careful history, physical examination, rectal examination, and nasogastric lavage may help localize the bleeding site and focus the differential diagnosis. This should be routine while resuscitating the patient. However, purging the colon for urgent colonoscopy may be the most definitive way to combine diagnosis and treatment of bleeding colonic lesions. Complete colonoscopy with intubation of the terminal ileum is recommended, and also examination of the rectum with a slotted anoscope. If those examinations are negative, a push enteroscopy is recommended for combined diagnosis and treatment. With recent advances in colonoscopic hemostasis, patients will benefit from diagnosis and treatment by experienced colonoscopists. Also, urgent colonoscopy after purge has been reported to be more cost-effective than elective colonoscopy or other strategies for diagnosis of severe hematochezia.