Ischemic colitis: A forgotten entity. Results of a retrospective study in 118 patients.

OBJECTIVE: The aim of our study was to document our 6-year experiences in identifying the clinical characteristics, laboratory findings, risk factors and the outcomes of patients with ischemic colitis (IC) in a community hospital setting. METHODS: The medical records of patients who were diagnosed with IC from 2007 to 2013 in two community hospitals were retrospectively reviewed. Their clinical characteristics, laboratory results, radiological, endoscopic and histological evidence, anatomic location of the lesion, comorbidities, concomitant use of drugs, and so on, were collected. RESULTS: A total of 118 patients with IC was identified, most were elderly individuals with a female predominance. The most common symptoms were abdominal pain, rectal bleeding and diarrhea. Hypertension, hyperlipidemia, coronary artery disease and diabetes mellitus were the most common comorbidities. Erythema, edema and erosions/ulcerations were the most common endoscopic findings. Left colon was the most affected location of lesion (84.8%), and there was one case of pancolitis. The descending colon was the most common affected segment, while rectum was the least affected segment. Severe IC occurred in 12.7% of the patients. Death within 30 days from the diagnosis of the disease occurred in 4.2%. CONCLUSIONS: IC is majorly occurred in elderly with a female predominance. Cardiovascular disease and its associated risk factors are the most common comorbidities. Left colon is the most affected location of the disease and the overall mortality rate was 4.2%. Physicians should make every effort to identify these patients, especially those with high risks.

Is CT Angiogram of the Abdominal Vessels Needed following the Diagnosis of Ischemic Colitis? A Multicenter Community Study.

Background. CT angiogram is frequently obtained after diagnosis of ischemic colitis (IC). Aims. To investigate the vascular findings of CT angiogram as compared to contrast-enhanced CT scan and whether this modality changes the management or prognosis of IC. Methods. We conducted a retrospective analysis of patients with IC from 2007 to 2013. Results. CT angiogram was performed in 34 patients (28.81%), whereas contrast-enhanced CT scan was performed in 54 patients (45.76%). In CT angiogram group, 8 patients (23.5%) had atherosclerotic changes. Stenosis was found in 12 patients (35.3%) (9: celiac trunk, 3: SMA). Among this group, one patient underwent colectomy and another underwent angioplasty of the celiac trunk who died within 30 days. Among contrast-enhanced CT scan group, 5 patients (9.3%) had atherosclerotic changes. Stenosis was found in 5 patients (9.3%) (3: celiac trunk, 1: SMA, and 1: IMA). Among this group, 3 patients had colectomy and one died within 30 days. There was no statistical difference between both groups in all vascular findings except the stenosis which was higher in CT angiogram group (P = 0.0025). Neither the need for surgery nor all-cause mortality was different between both groups. Conclusion. CT angiogram did not provide any useful findings that altered the management or the prognosis of IC.

Risk factors of recurrent ischemic colitis: a multicenter retrospective study.

BACKGROUND/AIMS: Recurrence of ischemic colitis (IC) has not been studied extensively. The aim of this study was to investigate the characteristics of recurrent IC in the community setting and to identify any risk factors. METHODS: We conducted a retrospective study in two community hospitals. Medical records of patients with IC from January 2007 to January 2013 were reviewed. Demographic details, clinical features, co- morbidities, concomitant use of medications,laboratory studies, imaging findings, endoscopic and histological features, surgery, hospital stay, and death within 30 days were collected. Patients were divided into two groups (recurrent IC group, non-recurrent IC group). RESULTS: A total of 118 patients with IC were identified. IC recurred in 10 patients (8.5%) during the study period. Half of the patients in the recurrent IC group were current smokers as compared to only 18.7% of patients in the non-recurrent group. In the recurrent IC group, 20.0% of patients never smoked as compared to 61.7% in the non-recurrent group (p=0.027).Abdominal aortic aneurysm (AAA) was more frequent in the recurrent IC group (40.0% vs. 4.7%; p=0.003). No differences in other clinical symptoms, CT scan findings, comorbidities, endoscopic features, or use of concomitant medications were observed between the two groups. The need for surgical intervention, blood transfusion, intensive care unit stay, mechanical ventilation,length of hospital stay, and anatomic location of affected segments did not differ between the two groups. CONCLUSIONS: IC recurred in 8.5% of patients during the six-year study period. Current smoking status and presence of AAA were identifying risk factors for recurrence of IC.

Metastatic infiltrating ductal carcinoma of the breast to the colon: a case report and literature review.

True metastatic involvement of the colon is rare. Colonic metastases occur most commonly secondary to peritoneal metastases from intra-abdominal malignancies. Breast cancer is the most common malignancy that metastasizes hematogenously to the colon. Colonic metastatic disease mimics primary colonic tumors in its presentation. Colonic metastatic involvement is a poor prognostic sign, and the pathologist should be informed about the history of the primary breast cancer when examining the pathologic specimens. In this paper, we report a case of an ileocecal mass found to be histologically consistent with metastatic ductal breast cancer, and then we review the literature about breast cancer metastases to the gastrointestinal tract in general and colon in particular.

Klippel-Trenaunay Syndrome Causing Life-Threatening GI Bleeding: A Case Report and Review of the Literature.

Klippel-Trenaunay syndrome (KTS) is a rare congenital syndrome of vascular malformations and soft tissue and bone hypertrophy. Vascular malformations can affect multiple organ systems. Involvement of the gastrointestinal (GI) tract is uncommon in KTS, but it can be a source of life-threatening bleeding. We report a case of a 32-year-old male with a known diagnosis of KTS who presented with a life-threatening rectal bleeding and was treated with proctosigmoidectomy and massive blood products transfusion. He expired after a long hospitalization. We then review the literature on KTS and management of some of its complications.