Analysis of the significant diagnostic signs and prognostic factors of gangrenous ischemic colitis

• Published in: Nihon Kyukyu Igakukai Zasshi Vol. 24; no. 3; pp. 141 - 148
• Main Authors: Ueda, Kentaro, Iwasaki, Yasuhiro, Yamazoe, Shinji, Kawazoe, Yu, Kawashima, Syuji, Yamaue, Hiroki, Kato, Seiya
• Format: Journal Article
• Language: English
• Published: Japanese Association for Acute Medicine 15.03.2013
• Subjects: chronic atherosclerotic diseases; ischemic intestinal necrosis; lactate; SIRS
• ISSN: 0915-924X; 1883-3772
• DOI: 10.3893/jjaam.24.141

Background: Gangrenous ischemic colitis occurs in about 10% of patients with acute ischemic colitis, and requires surgery as soon as possible. However, it cannot almost be diagnosed easily in the elderly due to the lack of clear signs of necrotic inflammation, and the mortality rate is about 60% in elderly patients. We herein clarify the significant diagnostic signs and prognostic factors of gangrenous ischemic colitis. Method: We reviewed 24 patients who underwent emergency surgery for gangrenous ischemic colitis between 2002 and 2010. Results: The average age of 24 patients was 77.4 years. Before surgery, all patients had some underlying atherosclerotic disease and signs of systemic inflammatory response syndrome (SIRS), and 87.5% had abnormally elevated lactate levels, whereas only 66.7% had signs of peritoneal irritation. Furthermore, 45.8%, 37.5%, 70.8% and 29.1% of patients had DIC, shock vital, metabolic acidosis and perforation of the colon, respectively. A Hartmann’s operation, which resected the necrotic colon, was performed in 23 patients, and a colectomy followed by primary anastomosis was performed in one patient, and the overall survival rate was 58.3%. Next, to examine the risk factors affecting the survival of these patients, both univariate and multivariate analyses using logistic regression were performed. A short time from onset of symptoms to surgery (<24hr) was the only independent prognostic determinant of survival identified by this study (p<0.05). Conclusion: To obtain an accurate diagnosis, evaluation of SIRS signs, elevated lactate and underlying atherosclerotic disease in the elderly are very useful, although the presence of signs of peritoneal irritation is infrequent. An emergency operation should be performed within 24 hours from the onset of symptoms in order to improve the prognosis.