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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective analysis was conducted to quantitatively assess eight suspected risk factors for the development of bowel ischemia after abdominal aortic aneurysmectomy. Eighteen patients were studied and compared with 100 randomly selected control subjects who underwent similar operations during the same time period in five Honolulu hospitals, but in whom the complication did not develop. Prolonged cross-clamp time, hypoxemia, ruptured aneurysm, hypotension, and arrhythmia (supraventricular and ventricular) occurred with significantly greater frequency among the patients with ischemia when compared with the control subjects. Age and other preexisting cardiovascular or gastrointestinal diseases did not significantly correlate with risk of postoperative colon ischemia. In addition, the technique of aortic grafting did not significantly influence the risk of development of ischemic colitis, but the number of patients in this study is too small to provide meaningful data on that point.
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PMID:Ischemic colitis after aortic aneurysmectomy. 683 67

Although ischemic colitis is not rare in the elderly with episodes of ischemia involving the heart and brain, clinical features of mild cases (transient type) have seldom been reported. Whereas the diagnostic findings of ischemic colitis are said to be longitudinal ulcers and stricture, longitudinal ulcers were noted only in 38% of the transient type in our series. For the correct diagnosis of the transient type, it was necessary to observe slight mucosal changes such as edema, congestion and petechiae by colonoscopy. It is emphasized that for the diagnosis of the mild transient type of ischemic colitis emergency colonoscopy must be performed as soon as possible after the onset of abdominal pain or rectal bleeding.
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PMID:Analysis of the clinical features of ischemic colitis. 687 95

From December 1964 to June 1980, 569 kidney allotransplants were performed in 524 patients at the University Hospital in Zurich. Necrokidneys were used exclusively. Twelve of these patients exhibited severe colonic complications: four perforations (1 perforated diverticulitis of the sigmoid, 1 perforation of the cecum during cytomegalovirus infection, 2 cases of ischemic colitis), 5 cases of ischemic colitis without perforation, and 3 patients with erosive colitis. In 9 of the 12 patients, hypotonic episodes were noted 4-17 days previously. The 2% complication rate in our patients is comparable with the mean rate of complications mentioned in the literature (2.4%). The lethality of 75% also corresponds with the results of other authors. The most important pathogenetic factor for colonic complications is ischemia; prevention of hypotonic episodes after renal transplantation is therefore mandatory.
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PMID:[Colonic complications after renal transplantation (author's transl)]. 705 May 69

Computed tomography (CT) performed on two patients with abdominal pain showed irregular, segmental thickening of the submucosa of the colon that proved to be due to ischemic colitis. In one case, CT showed narrowing of the lumen of the right colon by a polypoidal mass that was clearly the CT analog of thumbprinting. In the second case, CT was used as an alternative to barium studies to monitor the course of the patient. It is concluded that CT can be useful in the diagnosis and management of colonic ischemia.
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PMID:Ischemic colitis demonstrated by computed tomography. 717 28

The blood flow within the walls of the digestive tract must be sufficient to maintain its structural and functional integrity. All episodes of vascular insufficiency cause ischemic damage to the organ and carry the threat of diffuse or focal necrosis. Certain forms of ischemic colitis or proctitis arise from episodes of reduced peripheric or splanchnic blood flow; indeed, those which do not culminate in necrosis of the colonic wall are more frequently caused by hemodynamic disorders than by vascular occlusions. The crisis is often mitigated by the development of collateral circulation; this is, however, of rather poor quality so patients become very vulnerable to subsequent slight changes in cardiac output. Necrotic, gangrenous ischemic colitis arises from a combination of occlusive damage to the arteries and general hemodynamic disturbances. The vascular insufficiency may be slight or severe, temporary or long-lasting, localized or diffuse. In addition, the attack occurs in a septic medium in the presence of abundant microbial flora which may be highly pathologic. Thus infection complicates and aggravates the ischemic damage, resulting in the gangrenous aspect of the lesion tending to hide its ischemic origin. Indeed, the variability of the manifestations of the disease in one of its primary characteristics, and is a function of the different causative factors. A knowledge of the anatomy and pathophysiology of the splanchnic circulation and its hemodynamics is essential for a full appreciation of the diagnosis and treatment of the disorders, and for the adoption of the aggressive approach necessary to improve the poor prognosis of ischemic diseases of the colon and rectum. All treatment should be based on 1) constant, prolonged intensive care; 2) precise monitoring of any change in status; 3) rapid excision of any necrotic (often gangrenous) tissue. Ischemic colitis is most likely to occur in elderly patients with a history of cardiovascular disease, but can also affect younger individuals. It is a frequent, potentially lethal, entity. Although it can be classified as a separate disease on the basis of its clinical, radiological and anatomical characteristics, it is often confused with other disorders of the colon. Although the abdominal surgeon is most likely to be concerned with this disease, the vascular surgeon incising the lower aorta should always be on the look-out for segmentary ischemia of the distal colon which may occur following operation.
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PMID:Ischemic diseases of the large intestine. 727 5

Fifteen patients with ischemia of the colon are presented. The majority showed a similar clinical presentation with hematochezia, abdominal pain, and diarrhea in an elderly patient population having associated disease. Colonoscopy was abnormal in all patients studied. Three endoscopic stages were recognized; (1) acute stage characterized by petechiae, pallor, and hyperemia; (2) subacute stage consisting of ulceration and exudation; and (3) chronic stage characterized by stricture, decrease in haustrations, and mucosal granularity. Conventional barium enemas were abnormal and suggested ischemic colitis in six of 15 patients. Rigid proctoscopy was normal or demonstrated nonspecific proctitis in 12 of 15 patients studied. Colonoscopic biopsies demonstrated superficial inflammatory changes in all patients. Thirteen patients had complete mucosal healing endoscopically in 2 weeks to 3 months with stricture developing in four patients. Because ischemic colitis is a distinct subtype of ischemic bowel disease most often limited to the superficial mucosa, colonoscopy is an alternative and usually safe modality in the diagnosis of this entity and proved more accurate that conventional x-ray and proctoscopy.
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PMID:Colonoscopy in ischemic colitis. 729 23

The records of 81 patients with colitis whose symptoms began after the age of 50 years were analyzed to determine the importance of ischemia as a cause of colitis in this age group and to evaluate the accuracy of previous diagnoses. Patients were classified by clinical, roentgenological and pathologic criteria. A retrospective diagnosis of ischemic colitis was made in three-fourths of the patients, one-half of whom had original discharge diagnoses of ulcerative, Crohn's or nonspecific colitis. This study supports our belief that ischemia is the most common cause of colitis beginning in patients older than 50 years of age. Moreover, the incorrect diagnosis of idiopathic inflammatory bowel disease in a large proportion of these patients may explain why colitis has been reported to behave differently in the elderly than in the young.
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PMID:Colitis in the elderly. A reappraisal. 731 20

Ischaemic diseases of the large intestinal wall is a characteristic syndrome caused by vascular insufficiency of varying degrees. The ischaemia results from haemodynamic disturbances and often arises in spite of the patency of the vessels. The mucosa of the intestine is the tissue layer that is most vulnerable to ischaemia. Ischaemia of the colon occurs in the presence of a microbial flora that is often highly pathogenic, and hence the lesions rapidly become infected. For this reason the inflammatory features of the disease tend to conceal its vascular origin and ischaemic colitis has often been confused with other infectious, inflammatory, ulcero-haemorrhagic disorders of the large intestine. Although the syndrome may occur in any patient, it is much more common in elderly subjects with a history of arteriesclerosis and cardiac disease. Two main varieties can be identified, depending on the extent of the vascular insufficiency. In the first, the lesion may heal spontaneously or evolve towards fibrous strictures of the colonic wall; in the second, gangrenous necrosis of the colon or rectum may develope, the clinical picture of which has more in common with an "acute abdomen' than with ulcerative disease of the colon.
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PMID:[Ischemic disorders of the large intestinal wall. Ischemic colitis and rectitis secondary to intrinsic vascular disorders]. 740 18

The records of 27 patients with colonic ischemia were reviewed. Twelve patients had typical reversible or transient ischemic colitis. Thirteen patients had an ischemic stricture or gangrene of the colon that required operation. Two of the patients have asymptomatic strictures of the splenic flexure and are under observation. The sigmoid colon in our series of patients was the most frequent area of symptomatic stricture formation. Any patient with ischemic colitis, especially that involving the sigmoid colon, should be observed closely for the development of a stricture. Surgical intervention is indicated only after colonoscopy and careful evaluation of symptoms and risk factors.
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PMID:Comparison of transient ischemic colitis with that requiring surgical treatment. 740 4

Ischemic changes in the colon that progress to gangrene present diagnostic and therapeutic difficulties associated with poor survival. During the past 10 years, 36 patients with colonic ischemia were treated. Two clinical groups were evident. The spontaneous ischemic colitis group (type I) included 17 patients who were well before the onset of gastrointestinal symptoms. The cause of type I ischemic colitis is not apparent; it is attributed to occlusive or nonocclusive ischemia. The other group (type II) included 19 patients who developed ischemia of the colon associated with shock secondary to various disease processes. Radiographic evidence of distended bowel correlated well with full-thickness necrosis as determined clinically or pathologically. Twenty-one patients died, for a mortality rate of 58 percent. While full-thickness gangrene was fatal in 71 percent of the patients, mucosal necrosis only was associated with an 88 percent survival rate. The results of treatment should improve with an increased awareness of ischemic colitis, earlier appropriate operative intervention, and more appropriate use of ileostomy and colostomy.
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PMID:Spontaneous and shock-associated ischemic colitis. 745 97


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