Retrospective Analysis Of Clinical Features Of 82 Cases Of Ischemic Colitis

PurposeBy comparing the data of gangrenous and non-gangrenous ischemic colitis patients,identifing the clinical features of different degrees of ischemic colitis,and the risk factors of IC were analyzed to improve the clinicians' understanding of the disease and to reduce missed diagnosis and misdiagnosis.MethodsCollected data of 82 cases of IC from Department of Gastroenterology of our hospital from January 2010 to December 2017.According to Marston's IC classification we extracted general conditions,clinical manifestations,basic diseases,laboratory tests,imaging examinations,treatment,and transfer return the information and perform statistical analysis.Results1.General situation: 82 cases of IC patients included non-gangrene type 70 cases,gangrene type 12 cases,male to female ratio was 1:1.41,and the age of onset was 50-80 years old.The heart rate of gangrene group was 85.2±13.19 beats/min on the day of admission,and 73.5±8.47 beats/min for non-gangrene groups.Compared with non-gangrene patients,the average age of gangrene patients was greater and the heart rate was faster on the day of admission.2.Clinical manifestations: Abdominal pain was the most common(74/82,90.24%).More than half of the patients showed abdominal pain in the left lower,45 patients had bloody stools(54.88%),and some patients had diarrhea,bloating,nausea,vomiting and fever and other symptoms.Left lower abdominal pain was more common in non-gangrenous patients.Patients with gangrene had more common symptoms of lower right abdominal pain and bloating(P<0.01).Full abdominal pain and fever only occurred in gangrenous patients.3.Laboratory examination:56.1% of patients had elevated D-dimer(>0.5 mg/L),D-dimer average was 2.83±1.31 mg/L,and hemoglobin decreased in 35.4% of patients(<110 g/L L),the hemoglobin was 114.87±26.90g/L.In some patients,leukocyte(17%),lactate dehydrogenase(27%),serum creatinine(21%),and albumin(13%)decreased.The mean values of leukocyte,hemoglobin,and serum creatinine in patients with gangrene were 10.51±3.77/L,96.10±40.27g/Land 117.97±38.60umol/L respectively,6.89±2.74/L,118.08±13.13g/L and 89.70±27.90 umol/L occured in patients without gangrene,the difference was statistically signific ant.4.Imaging and endoscopy: 13 patients with abdominal vascular lesions were found,of which the highest positive rate of CTA(9/29,31.03%),35 cases of vascular color Doppler ultrasound found 3 cases of vascular disease,the positive rate was 8.57%.Abdominal CT plain scan and/or enhanced scan in 8 cases revealed vascular lesions in 1 case,of which Abdominal aorta and superior mesenteric artery lesions were the most common,with multiple manifestations of arteriosclerosis,thickening of the wall,loss of blood flow signals,and stenosis or occlusion of blood vessels.Seventy-seven patients underwent colonoscopy,of which 72 were found to have intestinal ischemic lesions under endoscopy,accounting for 93.51%.The most common manifestations of colonoscopy were hyperemia,erythema,erosion,and ulceration,which occurred in the opposite side of the mesenteric and normal.The mucosal demarcation is clear,often with segmental distribution.The patients with descending colon and splenic flexure are the most.The gangrene group IC has a higher ascending colon lesion than the non-growth group IC(P=0.01).5.Treatment and prognosis: The average number of days of hospitalization for gangrene patients was 13.13±4.83 days,compared with 5.92±4.24 days for nongangrene patients.All patients were treated with rehydration and improving circulation.In addition,13 patients were treated with antibiotics,5 patients were treated with anticoagulation,6 patients were treated with surgery,3 patients died during hospitalization,mortality rate(3.66%),and ventricular fibrillation occurred in one patient after surgery,one case was associated with multiple organ dysfunction,and one patient experienced hypotension shock.The remaining patients were hospitalized and discharged.6.A multivariate logistic regression analysis was used to show that the OR of age(>60 years old),hyperlipidemia,and coronary heart disease was greater than one.ConclusionIC occurs in the middle-aged and elderly people.Women are more common than men.They often have abdominal pain and blood in the stool.When the patient has right lower quadrant pain,full abdominal pain,and fever,gangrenous ICs should be considered.Non-gangrenous patients have more manifestations of lower left.Abdominal pain;elevated serum D-dimer and decreased hemoglobin have a certain prompting effect on the diagnosis of this disease,heart rate on the day of admission,serum white blood cells,hemoglobin and creatinine levels can predict the severity of IC;Colonoscopy has a higher level of the disease Diagnostic value,descending colon and spleen curvature is the most commonly involved site of IC,ascending colon disease is more common in patients with gangrene type;IC medical treatment effect is good,but when patients with toxic megacolon,digestive tract bleeding,peritonitis and other gangrene performance Surgery should be considered;Age(>60 years),hyperlipidemia,and coronary heart disease are independent risk factors for IC.