| BackgroundIschemic colitis(IC)is the most common form of intestinal ischemic injury and one of the most common causes of acute lower gastrointestinal bleeding.With the widespread utility of colonoscopy and computed tomography(CT),population aging and the awareness of the disease,IC has been increasingly diagnosed in the recent decades.The incidence of IC is increasing year by year.However,timely diagnosis of IC is still a challenge for clinicians.At present,the main reasons for the difficulty in IC diagnosis are as follows: 1.The clinical manifestations of IC are unspecific.IC is often confused with mesenteric ischemia,and misdiagnosed as infectious colitis,inflammatory bowel disease and other diseases;2.The pathophysiological mechanism and risk factors leading to IC have not been fully defined,and it is difficult to determine the factors that induce IC;3.In the International Classifiction of Diseases(ICD),there isn’t a unique diagnostic code for IC,and there are no specific diagnostic criteria for IC in clinical guideline.Although the overall prognosis of IC is good,delayed diagnosis may lead to the progress of IC.Severe IC usually requires surgical treatment,and the postoperative mortality rate is high.Establishing the diagnosis and initiating appropriate and timely treatment is critical for improving outcomes.Therefore,this paper will conduct a comprehensive retrospective analysis of patients who were diagnosed with IC in our hospital in recent years,to explore clinical characteristics and risk factors of IC,and to improve clinicians’ understanding of IC.This paper may provide theoretical support for the early diagnosis and treatment of IC.ObjectiveThe study was conducted to explore the clinical characteristics and risk factors of IC retrospectively,so as to improve the early diagnosis rate of IC,and to reduce misdiagnosis and mortality.MethodsA total of 62 patients with complete clinical data,who were diagnosed with IC by colonoscopy or surgery in the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2018,were collected,and 62 patients with normal colonoscopy during the same period were randomly selected as the control group.According to Marston’s IC classification criteria,the case group was divided into gangrenous group and non-gangrenous group.The Clinical data of case group and control group were collected and statistically analyzed.Results1.The 62 cases included 22 males and 40 females,with a male to female ratio of 1:1.82.The average age was 63.00±12.76 years old,and the majority is distributed from 50 and 80 years old.2.The he most common clinical manifestations were abdominal pain(82.3%),hematochezia(74.2%)and diarrhea(25.8%).Abdominal pain was mostly located in the left lower abdomen(47.0%)or around the umbilicus(29.4%),and bloody stools were mostly maroon(56.5%)or bright red(37.0%).3.Among the 62 cases in our study,the most common comorbidities were hypertension(45.2%),coronary heart disease(38.7%),cerebrovascular disease(24.2%),hyperlipidemia(24.2%),diabetes(22.6%),history of abdominal surgery(19.4%),fatty liver(19.4%),constipation(12.9%).The most common oral drugs were CCB(17.7%).4.In laboratory examination,WBC increased by 29.0%,anemia accounted for 12.9%,ALB decreased(< 30g/L)by 6.1%,d-dimer increased by 43.5%,the positive rate of CT,CTA and ultrasonography of abdominal large vessels were 72.2%,43.8% and 33.3% respectively.5.Most lesions were located in the left half colon(72.6%),sigmoid colon,descending colon and splenic curvature were the most frequently involved sites(66.1%,64.5% and 27.4%),and the main manifestations under colonoscopy were hyperemia(59.3%),edema(44.4%),erosion(66.7%),and ulceration(35.2%).The pathological manifestations were mostly non-specific inflammatory manifestations(97.7%).6.54 cases of nongangrene accepted medical treatment.8 cases of gangrene were treated with surgery,and 3 cases died(37.5%).There were significant differences between the gangrenous group and non-gangrenous group in age,gender,hematochezia,heart rate,isolated right hemicolon ischemia,WBC,ALB,d-dimer(p < 0.05)7.Univariate analysis showed statistically significant differences in age,hypertension,coronary heart disease,diabetes,and cerebrovascular disease(P < 0.05).Multivariate analysis showed that age(≥60 years old)and diabetes were independent risk factors for IC.Conclusion1.IC mainly occurs in descending colon,sigmoid colon and splenic curvature,it has no specificity in clinical manifestations,and it.Early colonoscopy is helpful for early identification of IC.For elderly patients with hypertension,coronary heart disease,diabetes,cerebrovascular disease and other basic diseases,the possibility of IC should be highly suspected when symptoms such as abdominal pain,hematochezia and diarrhea occur.2.older age,male gender,tachycardia,lack of hematochezia,isolated right colon ischemia,significantly increased WBC and d-dimer,and significantly decreased ALB may be predictive factors of gangrenous IC.3.Age(≥60 years old)and diabetes are independent risk factors for IC. |
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