Ischemic colitis: Spectrum of disease and outcome

Background. The aim of this study was to identify risk factors, clinical characteristics, and outcome of patients with colon ischemia. Methods. A 10-year (1992-2002) retrospective study was undertaken. Patients were identified from computerized hospital discharge information. Patient variables were entered into a computerized database and analyzed. Results. One hundred twenty-nine patients were identified. The mean age was 66 years (range, 29-98 years); 47% were male. Forty-three patients (33%) had chronic renal failure; 73 patients (57%) were receiving vasoactive drugs, and 72 patients (56%) had atherosclerosis. Fifty-four of 129 patients (42 %) had ischemic colitis in-hospital. Fifty-six of 129 patients (43 %) had melena; 49 of 56 patients (88 %) survived. Forty-three of 129 patients (33 %) had an acute abdomen; 22 of 43 patients (51 %) died. Seventy of 129 patients (54 %) were treated nonoperatively initially; the condition of 17 of 70 patients (24 %) required surgery. Of 76 patients who were treated operatively, 31 patients (41 %) died. Eleven patients at operation had ischemia without colon infarction or perforation; 5 of these patients (45 %) died. The overall mortality rate was 29 % (3 71129 patients). Conclusion. Ischemic colitis is associated with chronic renal failure and atherosclerosis. Patients commonly have an acute abdomen. The absence of colonic infarction does not ensure a favorable outcome. Patients who are felt to be candidates for nonoperative therapy have significant mortality rates. Mortality rates remain high, despite treatment.