Clinical Characteristics And Risk Factors Of Ischemic Colitis

Objective:To investigate and analyze the clinical data of patients with ischemic colitis,and to summarize the risk factors,clinical manifestations,endoscopic characteristics,laboratory examination characteristics and treatment outcome of patients with ischemic colitis in our hospital.Method:1.To review the clinical data of patients with ischemic colitis admitted to the second hospital of Hebei Medical University from January 1,2014 to January 31,2020,and to analyze the clinical characteristics,auxiliary examination and other data of the final 110 patients with ischemic colitis.According to whether there is intestinal ulcer in endoscopy,they are divided into ulcer group and non ulcer group.According to whether they are diagnosed with ischemic colitis on admission,they are divided into ulcer group and non ulcer group Colitis was divided into two groups: the first diagnosis group and the first misdiagnosis group.110 patients with ischemic colitis were compared with 110 patients with colonic polyps in the same period to explore the risk factors of ischemic colitis.2.Collect the clinical data of the patients,including age,gender,symptoms and signs,some laboratory examination results,abdominal CT / CTA results,colonoscopy and pathological results,misdiagnosed diseases,diagnosis and treatment process and prognosis,complications,medication history,personal history,etc.3.Retrospective case-control study method was used,SPSS 22.0 software was used for statistical analysis,and the clinical data of the patients were analyzed to understand the clinical characteristics of ischemic colitis.Result:1.General informationAmong 110 patients,42 were male(38.2%),68 were female(61.8%)and the ratio of male to female was about 1:1.62.14 cases(12.7%)were less than 40 years old,46 cases(41.8%)were 40-59 years old,50 cases(45.5%)were more than 60 years old.2.Clinical manifestationsThe most common symptoms were abdominal pain(87.3%),diarrhea(83.6%),hematochezia(87.3%),nausea(34.5%),vomiting(21.8%),abdominal distention(18.2%),fever(12.7%),dizziness(11.8%),tiredness(9%),palpitation(6.4%),stop defecation(3.6%).About 70.9% of them had abdominal pain,diarrhea and hematochezia.The main abdominal signs were tenderness(64.5%),rebound pain(7.3%),active or weak bowel sounds(10%,7.3%).The tenderness was mainly located in the lower abdomen(34.3%),the left lower abdomen(31.4%),and the umbilicus(10%).3.Endoscopy and pathology(1)Affected parts of colonoscopy: colonoscopy showed that 17.3% of the single part was involved,82.7% of the multiple parts were involved,including 11.8% of the whole colon.The most affected parts were descending colon,sigmoid colon,transverse colon,splenic flexure,rectum,hepatic flexure and ascending colon.2.7% of the patients were isolated from the right half of the colon.(2)Endoscopic manifestations: congestion and edema,erosion,erythema,unclear vascular texture,mucosal bleeding spots,ulcers,etc.Ulcers vary in size,shape and depth,most of which are longitudinal,irregular and circumjacent ulcers.In addition,sheet ulcers and ulcers with uplifts can also be seen.(3)Pathological manifestations: in this study,the pathological descriptions of ischaemic colitis are mainly submucous hemorrhage spot,hyaline degeneration,gland atrophy,and atypical non-specific changes,including mucosal erosion,acute and chronic inflammation of mucosa,epithelial dysplasia,fibrogenesis,crypt abscess,eosinophil infiltration,pigmentation,crypt deformation,etc.4.Imaging(1)Intestinal lesions: CT / CTA examination of 110 patients showed that there were 64 cases of intestinal lesions,the main lesions were thickening of the wall of the tube 71.9%,rough serous surface or margin 25%,exudation around the wall of the tube 48.4%,in addition to 10.9% of ascites or pelvic fluid,and 3.1% of intestinal dilatation.(2)Angiopathy: CT / CTA showed 66 cases of angiopathy,mainly arteriosclerosis 84.8%,abdominal aorta or mesenteric artery stenosis 27.3%,arterial intima thickening 7.6%,abdominal artery calcification 7.6%,arterial wall ulcer 6.1%,other lesions including arterial dissection,arteriovenous fistula,etc.,but less.(3)CT / CTA showed the presence of intestinal and vascular lesions in 33 cases(30%).5.Laboratory inspectionBlood routine examination was carried out in 110 patients,among which 45.5% patients showed an increase in leukocyte count,26.4% patients showed a decrease in hemoglobin,99 patients showed an increase in ESR,33.3% of them showed an increase in hs CRP,107 patients showed an increase in hs CRP,65.4% of them showed an increase in hs CRP,27 patients showed an increase in PCT,7.4% of them showed an increase.A total of 75 patients were tested for D-dimer,of which 61.3% were elevated,103 patients were tested for FIB,of which 4.9% were elevated.Electrolytes were detected in 110 patients.The serum potassium and calcium decreased in 16.4%(18 / 110)and 34.5%(38 / 110).65.5% of the 110 patients had ALB reduction in varying degrees.LDH was measured in 107 patients,15(14%)of whom had LDH increase.The results showed that the leukocyte of ulcer group was higher than that of non ulcer group,and the P value was less than 0.05,which was statistically significant.6.Misdiagnosis(1)The misdiagnosis rate of 110 cases of IC was about 39.1%.Most of them were misdiagnosed as colon cancer,ulcerative colitis and intestinal obstruction.(2)Comparison of misdiagnosed and non misdiagnosed cases: ischemic colitis is easy to be misdiagnosed as other diseases when fever occurs,and it is not easy to be misdiagnosed as other diseases when abdominal pain is the main symptom,P value is less than 0.05,which is statistically significant.7.Treatment and prognosisThe main treatment was conservative treatment in internal medicine.After conservative treatment,100 patients were discharged,accounting for 90.9%.9 patients were discharged without recovery.One patient died,accounting for 0.9% of the total.The patients died of peritonitis,septic shock and respiratory failure.8.Risk factorsSingle factor analysis showed that the p value of diabetes,cerebral infarction,diarrhea,chronic constipation,non steroidal anti-inflammatory drugs,calcium antagonists,women,age ≥ 60 years old were less than 0.05,which showed that the above risk factors were related to the occurrence of ischemic colitis.Conclusion:1.In this study,ischemic colitis is the most common in the age of 55-69 years old,54.5% in the young and middle-aged group,and 12.7% in the young group,which needs clinical attention.2.In clinic,abdominal pain is the first manifestation of the patients,and about 70.9% of the patients have abdominal pain,diarrhea and hematochezia.3.Sigmoid colon is the most common site of single site,descending colon + sigmoid colon is the most common site of multiple sites.14.3% of the total colon,21.8% of the rectum and 2.7% of the isolated right colon were involved.Microscopically,there are various manifestations,most of which are hyperemia,edema,ulcer and erosion of mucous membrane.The shape of ulcer is mostly longitudinal,irregular and annular.4.Ischemic colitis is easily misdiagnosed as other diseases when fever occurs,while abdominal pain is the main clinical manifestation.5.Age ≥ 60 years old,female,diabetes,cerebral infarction,diarrhea,chronic constipation,non steroidal anti-inflammatory drugs,calcium antagonists are the risk factors of ischemic colitis.