David Moszkowicz1, Christophe Trésallet1, Antoine Mariani1, Jérémie H Lefevre2, Gaëlle Godiris-Petit1, Séverine Noullet1, Jean-Jacques Rouby3, Fabrice Menegaux4. 1. Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France. 2. Department of Visceral Surgery, St-Antoine Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France. 3. Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France. 4. Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France. Electronic address: fabrice.menegaux@psl.aphp.fr.
Abstract
BACKGROUND: Acute ischaemic colitis can occur postoperatively, mainly after aortic surgery, or spontaneously. Surgical treatment is debated. Study aim was to describe factors related to ischaemic colitis severity, determine if postoperative and spontaneous ischaemic colitis share similar outcomes, and evaluate results of standardized management. METHODS: 191 consecutive cases of ischaemic colitis observed from 1997 to 2012 were retrospectively analyzed: 119 (62%) after surgery and 72 (38%) spontaneous. Colon resection was performed for endoscopic type 2 colitis with multiple organ failure, and for every type 3. Types 1 and 2 without multiple organ failure were managed nonoperatively. RESULTS: Seventeen patients (9%) were managed nonoperatively, without mortality. Mortality rate after resection was 48% (84/174), within 9 days (range, 0-152). Multivariate analysis found 2 independent factors associated with postoperative death: age≥75 years and multiple organ failure. The context in which ischaemic colitis occurred was not a risk factor for mortality. Mortality rates were 51% for final type 3 (66% with multiple organ failure, 17% without), 53% for final type 2 with multiple organ failure, and 0% for type 1 or type 2 without multiple organ failure. CONCLUSION: An aggressive surgical approach in patients with ischaemic colitis seems justified in patients with multiple organ failure and findings of severe form of ischaemia at endoscopy.
BACKGROUND: Acute ischaemic colitis can occur postoperatively, mainly after aortic surgery, or spontaneously. Surgical treatment is debated. Study aim was to describe factors related to ischaemic colitis severity, determine if postoperative and spontaneous ischaemic colitis share similar outcomes, and evaluate results of standardized management. METHODS: 191 consecutive cases of ischaemic colitis observed from 1997 to 2012 were retrospectively analyzed: 119 (62%) after surgery and 72 (38%) spontaneous. Colon resection was performed for endoscopic type 2 colitis with multiple organ failure, and for every type 3. Types 1 and 2 without multiple organ failure were managed nonoperatively. RESULTS: Seventeen patients (9%) were managed nonoperatively, without mortality. Mortality rate after resection was 48% (84/174), within 9 days (range, 0-152). Multivariate analysis found 2 independent factors associated with postoperative death: age≥75 years and multiple organ failure. The context in which ischaemic colitis occurred was not a risk factor for mortality. Mortality rates were 51% for final type 3 (66% with multiple organ failure, 17% without), 53% for final type 2 with multiple organ failure, and 0% for type 1 or type 2 without multiple organ failure. CONCLUSION: An aggressive surgical approach in patients with ischaemic colitis seems justified in patients with multiple organ failure and findings of severe form of ischaemia at endoscopy.
Authors: Joshua Tseng; Brandi Loper; Monica Jain; Azaria V Lewis; Daniel R Margulies; Rodrigo F Alban Journal: Trauma Surg Acute Care Open Date: 2017-11-02