OUTCOME OF PATIENTS WITH TOTAL COLONIC ISCHEMIA

PURPOSE: In this study, we sought to determine the outcome of patients with ischemic colitis, comparing patients with segmental disease with those with total colonic ischemia. METHODS: Patients with the diagnos is of ischemic colitis over the past six years were selected and revie wed for demographics, presenting symptoms, diagnosis, and treatment. R ESULTS: Forty-three consecutive patients with ischemic colitis were id entified and were grouped into those with segmental ischemic colitis a nd total colonic ischemia. Mean age was 68.8 years; 28 of 43 patients (65 percent) were males. Diagnosis was established by colonoscopy in 3 1 of 43 patients (72 percent), whereas in the remainder, diagnosis was made in the operating room. Ischemic colitis developed in the hospita l in 17 of 43 patients (40 percent) during admission for an unrelated illness. In 6 of 43 (14 percent) of these patients, ischemic colitis d eveloped following surgery. Thirty-one of 43 patients (72 percent) wer e found to have segmental colitis, 11 of 31 patients (35 percent) were successfully managed nonoperatively. Segmental colitis was present in 31 of 43 patients (72 percent), and 12 of 31 (35 percent) of these pa tients were successfully managed nonoperatively. In the patients with segmental colitis who required surgery, the 30-day mortality rate was 22 percent. Among 12 of 17 patients (71 percent) with segmental ischem ia treated by resection and stoma, 9 of 12 (75 percent) underwent even tual stoma closure. All 12 patients with total colonic ischemia requir ed surgery, and 9 of 12 patients (75 percent) died. CONCLUSION: Ischem ic colitis occurs commonly during an unrelated hospital admission and following previous surgery. Most patients treated by resection and sto ma undergo stoma closure. Total colonic ischemia carries a worse progn osis than segmental colonic ischemia.