HYPOTHESIS: Under standard conditions following aortic reconstruction, nonocclusive ischemic colitis (IC) type 1 (mucosal ischemia) and type 2 (mucosal and muscularis ischemia) can be managed nonoperatively, whereas type 3 (transmural ischemia) requires emergency surgery. Our objective was to standardize the surgical approach for IC complicating aortic reconstruction. DESIGN: Retrospective cohort study. SETTING: General surgery, vascular surgery, anesthesiology, and critical care units in a university-affiliated hospital. METHODS: From January 5, 1997, to December 15, 2003, 49 cases of IC complicating aortic reconstruction were diagnosed (rate, 2.7%). Nonoperative management was used for patients with type 1 or type 2 without multiple organ failure (MOF). All patients with type 3 or with type 2 with MOF underwent urgent resection of the ischemic colon without anastomosis. RESULTS: Immediate surgery was performed on 24 patients (49.0%). Nineteen (76.0%) of 25 patients without MOF and with transient endoscopic findings underwent secondary surgery for progression to final IC type 3 (16 patients) or to final IC type 2 with MOF (3 patients). Twenty-three (53.5%) of 43 patients died after colorectal resection (overall mortality, 46.9%). Factors causing significant risk of death were surgery, MOF, final IC type, and amount of perioperative transfusion. The mortality was 57.1% for final IC type 3, 37.5% for final IC type 2 with MOF, and 0% for final IC type 1 or type 2 without MOF. CONCLUSIONS: Selective management of postoperative IC, based on MOF and the degree of ischemia, is the suggested course of action. For patients with mild ischemia and MOF, an aggressive approach is recommended.
HYPOTHESIS: Under standard conditions following aortic reconstruction, nonocclusive ischemic colitis (IC) type 1 (mucosal ischemia) and type 2 (mucosal and muscularis ischemia) can be managed nonoperatively, whereas type 3 (transmural ischemia) requires emergency surgery. Our objective was to standardize the surgical approach for IC complicating aortic reconstruction. DESIGN: Retrospective cohort study. SETTING: General surgery, vascular surgery, anesthesiology, and critical care units in a university-affiliated hospital. METHODS: From January 5, 1997, to December 15, 2003, 49 cases of IC complicating aortic reconstruction were diagnosed (rate, 2.7%). Nonoperative management was used for patients with type 1 or type 2 without multiple organ failure (MOF). All patients with type 3 or with type 2 with MOF underwent urgent resection of the ischemic colon without anastomosis. RESULTS: Immediate surgery was performed on 24 patients (49.0%). Nineteen (76.0%) of 25 patients without MOF and with transient endoscopic findings underwent secondary surgery for progression to final IC type 3 (16 patients) or to final IC type 2 with MOF (3 patients). Twenty-three (53.5%) of 43 patients died after colorectal resection (overall mortality, 46.9%). Factors causing significant risk of death were surgery, MOF, final IC type, and amount of perioperative transfusion. The mortality was 57.1% for final IC type 3, 37.5% for final IC type 2 with MOF, and 0% for final IC type 1 or type 2 without MOF. CONCLUSIONS: Selective management of postoperative IC, based on MOF and the degree of ischemia, is the suggested course of action. For patients with mild ischemia and MOF, an aggressive approach is recommended.
Authors: Seija Sipola; Hannu Syrjälä; Vesa Koivukangas; Jouko J Laurila; Tuomo Karttunen; Pasi Ohtonen; Juha Saarnio; Tero I Ala-Kokko Journal: World J Surg Date: 2013-02 Impact factor: 3.352
Authors: A Mariani; D Moszkowicz; C Trésallet; F Koskas; L Chiche; R Lupinacci; F Menegaux Journal: Tech Coloproctol Date: 2014-01-17 Impact factor: 3.781
Authors: Elie Zogheib; Cyril Cosse; Charles Sabbagh; Simon Marx; Thierry Caus; Marc Henry; Joseph Nader; Mathurin Fumery; Michael Bernasinski; Patricia Besserve; Faouzi Trojette; Cedric Renard; Pierre Duhaut; Said Kamel; Jean-Marc Regimbeau; Hervé Dupont Journal: Ann Intensive Care Date: 2018-04-18 Impact factor: 6.925