Ischemic colitis in young adults: A single-institution experience

Ischemic colitis is not well characterized in the young adult population, d espite its commonness in older patients. The aim of this study was to inves tigate the demographics, etiology, clinical features, and prognosis of isch emic colitis in young adults. We conducted a retrospective study of 39 youn g adults (< 50 years of age) diagnosed with ischemic colitis over a period of 9 years (1990 to 1998). The mean age at diagnosis was 38 +/- 2 years (ra nge 18 to 49 years); the female:male ratio was 1.8. Fifty-two percent (13 o f 25) of women were using oral contraceptives at the time of diagnosis. Oth er potential associations identified were vascular thromboembolism (4 of 39 ), vasoactive drugs (4 of 39), hypovolemia (4 of 39), and vasculitis (2 of 39); 19 patients (49%) had no identifiable predisposing factors. Dominant p resenting symptoms were abdominal pain (77%), bloody diarrhea (54%), and he matochezia (51%). Most patients were diagnosed at colonoscopy, and most dis ease was left sided. Twenty-nine patients were successfully managed with in travenous fluids, broad-spectrum antibiotics, and bowel rest; 10 patients r equired surgery. There was one disease-related death in the operative group . We found a strong female predominance and an association with oral contra ceptive use, but almost half of the patients did not have an identifiable e tiology. Mortality from ischemic colitis in this patient population is low.