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

ABSTRACT

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.