[Ischemic colitis: two forms of clinical presentation and outcome]. / Colitis isquémica: dos formas de evolución clínica.

OBJECTIVES: To characterize the clinical presentation and outcomes of ischemic colitis in our environment with a view to identifying risk factors. METHOD: Fifty-one patients diagnosed in our hospital with ischemic colitis over a 5-year period (1998-2002) were retrospectively analyzed. Demographic data, clinical symptoms, diagnosis and treatment were studied. Two groups (surgical patients [n = 28] and nonsurgical patients [n = 23]) were compared. RESULTS: No significant differences between the two groups were found in demographic data and associated disease. Diagnosis was performed by colonoscopy in nonsurgical patients and by analysis of the surgical specimen in almost all surgical patients. The presenting symptom was lower gastrointestinal bleeding in nonsurgical patients (p < 0.05) and peritonism in surgical patients (p < 0.05). Mortality was significantly higher in patients older than 80 years than in younger patients. CONCLUSIONS: Lower gastrointestinal bleeding was more common as the presenting symptom in transitory forms of ischemic colitis. An acute abdomen indicates serious forms requiring surgery. Therefore the initial clinical symptoms determine the treatment provided. Advanced age is a poor prognostic factor for ischemic colitis. Risk factors in our series were presentation as acute abdomen and advanced age.

Colitis isquémica: dos formas de evolución clínica / Ischemic colitis: two forms of clinical presentation and outcome

Objetivos. Caracterizar la presentación y los resultados de la enfermedad en nuestro medio con el fin de identificar los factores de riesgo. Método. Se ha estudiado retrospectivamente, en un período de 5 años (1998-2002), a 51 pacientes diagnosticados de colitis isquémica en nuestro centro, mediante la revisión de los datos demográficos, los síntomas clínicos, los métodos diagnósticos y el tratamiento. Se comparan 2 grupos: el de pacientes operados (grupo O; n = 28) y el de no operados (grupo NO; n = 23). Resultados. No encontramos diferencias significativas entre los 2 grupos en cuanto a los datos demográficos ni a la enfermedad asociada. En los pacientes tratados médicamente, la enfermedad se diagnostica a través de una colonoscopia, mientras que en los operados prácticamente siempre se consigue el diagnóstico gracias al análisis de la pieza de resección. Los pacientes del grupo NO comienzan con rectorragia (p < 0,05) mientras que los del grupo O acuden por clínica de peritonismo (p < 0,05). La mortalidad entre los pacientes mayores de 80 años es significativamente mayor que en los de menor edad. Conclusiones. La presentación clínica en forma de rectorragia es más frecuente en las formas de colitis isquémica transitorias, mientras que el abdomen agudo define las formas graves que precisan intervención quirúrgica; la clínica inicial es la que determina el tratamiento recibido. Asimismo, la edad avanzada es un factor de mal pronóstico de la enfermedad. En nuestra serie, la presentación en forma de abdomen agudo y la edad avanzada se definen como factores de riesgo (AU)

Objectives. To characterize the clinical presentation and outcomes of ischemic colitis in our environment with a view to identifying risk factors. Method. Fifty-one patients diagnosed in our hospital with ischemic colitis over a 5-year period (1998-2002) were retrospectively analyzed. Demographic data, clinical symptoms, diagnosis and treatment were studied. Two groups (surgical patients [n = 28] and nonsurgical patients [n = 23]) were compared. Results. No significant differences between the two groups were found in demographic data and associated disease. Diagnosis was performed by colonoscopy in nonsurgical patients and by analysis of the surgical specimen in almost all surgical patients. The presenting symptom was lower gastrointestinal bleeding in nonsurgical patients (p < 0.05) and peritonism in surgical patients (p < 0.05). Mortality was significantly higher in patients older than 80 years than in younger patients. Conclusions. Lower gastrointestinal bleeding was more common as the presenting symptom in transitory forms of ischemic colitis. An acute abdomen indicates serious forms requiring surgery. Therefore the initial clinical symptoms determine the treatment provided. Advanced age is a poor prognostic factor for ischemic colitis. Risk factors in our series were presentation as acute abdomen and advanced age (AU)