COLONIC ISCHEMIA AS AN EARLY MARKER OF ACUTE MESENTERIC ISCHEMIA

  • Andreia Pires Coelho Angiology and Vascular Surgery Department; Centro Hospitalar Vila Nova de Gaia e Espinho; Faculdade de Medicina da Universidade do Porto
  • Miguel Lobo Angiology and Vascular Surgery Department; Centro Hospitalar Vila Nova de Gaia e Espinho
  • Jaime Rodrigues Angiology and Vascular Surgery Department; Centro Hospitalar Vila Nova de Gaia e Espinho
  • Ricardo Gouveia Angiology and Vascular Surgery Department; Centro Hospitalar Vila Nova de Gaia e Espinho
  • Jacinta Campos Angiology and Vascular Surgery Department; Centro Hospitalar Vila Nova de Gaia e Espinho; Faculdade de Medicina da Universidade do Porto
  • Rita Augusto Angiology and Vascular Surgery Department; Centro Hospitalar Vila Nova de Gaia e Espinho; Faculdade de Medicina da Universidade do Porto
  • Nuno Coelho Angiology and Vascular Surgery Department; Centro Hospitalar Vila Nova de Gaia e Espinho; Faculdade de Medicina da Universidade do Porto
  • Ana Carolina Semião Angiology and Vascular Surgery Department; Centro Hospitalar Vila Nova de Gaia e Espinho
  • Alexandra Canedo Angiology and Vascular Surgery Department; Centro Hospitalar Vila Nova de Gaia e Espinho; Faculdade de Medicina da Universidade do Porto
Keywords: Acute mesenteric ischemia, Colon ischemia, Early diagnosis

Abstract

Introduction: Acute mesenteric ischemia (AMI) and colonic ischemia (CI) may be quite intricate and appear in the same patient simultaneously or in different time frames. However, in the majority of patients with CI a specific occlusive vascular lesion cannot be identified, as opposed to AMI. According to the American College of Gastroenterology (ACG), CT angiography should be performed in all patients with severe CI in order to exclude AMI. The main purposes of this study were to stratify CI severity to determine if there was an association with the presence of AMI, and to identify determinants of AMI in severe CI.

Methods: The clinical data of all patients admitted with the diagnosis of CI from 2010 to 2014 were retrospectively reviewed.

Results: A total of 241 patients were included, 213 with isolated CI and 28 with CI+AMI. CI was stratified according to ACG severity classification. No cases of concomitant AMI were found in mild CI, 1.5% of patients with moderate CI and 56.8% of patients with severe CI had simultaneously AMI. The severe isolated CI was compared with the severe CI+AMI group. Hematochezia was found more frequently in isolated CI (p<0.001) whereas constipation and isolated right CI were more common in the CI+AMI group (p=0,021). At admission haemoglobin level was significantly higher in the CI+AMI (13.8±1.9 Vs 11.4±2.2; p<0.001) as was lactate level (7.6±4.6 Vs 2.4±1.3; p=0.001). Atrial fibrillation, coronary disease and isolated right colon ischemia were more common in the CI+AMI group (p<0.05). Other clinical findings were evaluated with no significant difference between groups.

Conclusions: The knowledge of an association between CI and AMI prompts to look for underlying occlusive disease in patients with severe CI. Our results based on the analysis of 241 patients with CI support the ACG recommendation for CT angiography in all patients with severe CI. Elevated lactate level, right isolated CI, atrial fibrillation and coronary disease are predictors of AMI in patients with severe CI in this study.

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Published
2018-12-21
Section
Original Article

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