The spectrum of ischaemic colitis

Objective Ischaemic colitis is generally considered a disease of the elderl y with considerable cardiovascular morbidity. We aimed to determine the eff ect of age, comorbidity and clinical presentation on type, severity and ana tomy of involvement of ischaemic colitis. Thrombophilic tendencies have bee n poorly studied and coagulation status was performed in available patients . Design Retrospective case identification with prospective follow-up. Setting University teaching hospital. Participants Twenty-four patients (16 female, mean age 64 years) with ischa emic colitis. Interventions Blood analysis for clotting tendencies. Main outcome measures Operation rates, death rates and frequency of clottin g abnormalities. Results Five patients (21%) were below the age of 45, and seven of the 24 h ad died by the time of follow-up. Four had died of ischaemic colitis during the acute episode. The four patients that died of ischaemic colitis had a more extensive and more severe type of disease and presented with worse cli nical features. The main predisposing factors were ischaemic heart disease in 12 (50%) and malignancy in five (26%). Six of the 24 cases (25%) had rig ht-sided lesions and this conferred a good prognosis. Shock, peritonism, ex tensive disease and uncontrolled atrial fibrillation were all poor prognost ic factors. Clotting factor abnormalities could be detected in three of nin e patients despite a time lapse between assay and episode of ischaemic coli tis. Conclusions Ischaemic colitis appears to have two patterns of severity. Ana tomical distribution is more variable than a developmental explanation of t he vascular supply. Clotting abnormalities may be detected in a minority ev en on retrospective testing. Eur J Gastroenterol Hepatol 11:295-303 (C) 199 9 Lippincott Williams & Wilkins.