Ischemic colitis surgery: Difference between revisions
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==Indications== | ==Indications== | ||
*Surgery is not the first-line treatment option for patients with ischemic colitis. Surgery is usually reserved for patients with either:<ref name="pmid14650467">{{cite journal| author=Baixauli J, Kiran RP, Delaney CP| title=Investigation and management of ischemic colitis. | journal=Cleve Clin J Med | year= 2003 | volume= 70 | issue= 11 | pages= 920-1, 925-6, 928-30 passim | pmid=14650467 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14650467 }} </ref><ref name="TheodoropoulouΚoutroubakis2008">{{cite journal|last1=Theodoropoulou|first1=Αngeliki|last2=Κoutroubakis|first2=Ioannis E|title=Ischemic colitis: Clinical practice in diagnosis and treatment|journal=World Journal of Gastroenterology|volume=14|issue=48|year=2008|pages=7302|issn=1007-9327|doi=10.3748/wjg.14.7302}}</ref> | *Surgery is not the first-line treatment option for patients with ischemic colitis. Surgery is usually reserved for patients with either:<ref name="pmid14650467">{{cite journal| author=Baixauli J, Kiran RP, Delaney CP| title=Investigation and management of ischemic colitis. | journal=Cleve Clin J Med | year= 2003 | volume= 70 | issue= 11 | pages= 920-1, 925-6, 928-30 passim | pmid=14650467 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14650467 }} </ref><ref name="TheodoropoulouΚoutroubakis2008">{{cite journal|last1=Theodoropoulou|first1=Αngeliki|last2=Κoutroubakis|first2=Ioannis E|title=Ischemic colitis: Clinical practice in diagnosis and treatment|journal=World Journal of Gastroenterology|volume=14|issue=48|year=2008|pages=7302|issn=1007-9327|doi=10.3748/wjg.14.7302}}</ref> | ||
**Sepsis | |||
**Sepsis | **Persistent fever and leukocytosis | ||
**Persistent fever and leukocytosis | |||
**Peritoneal irritation | **Peritoneal irritation | ||
**Protracted pain | **Protracted pain | ||
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==Surgery== | ==Surgery== | ||
* Surgery for ischemic colitis is as follows: | |||
* | ** 20% of patients with acute ischemic colitis will require surgery with an associated mortality rate of up to 60%. | ||
** Laparotomy confirms the diagnosis and all affected bowel is resected. | |||
* | ** Extent of resection should be guided by the distribution of disease seen on preoperative studies | ||
*** Resected segment should be examined in the operating room for mucosal injury. | |||
==Contraindications== | ==Contraindications== | ||
Revision as of 15:00, 8 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]
Overview
The mainstay of treatment for ischemic colitis is medical therapy. Surgery is usually reserved for patients with either sepsis, persistent fever and leukocytosis, peritoneal irritation, protracted pain, diarrhea or bleeding, protein-losing colopathy for more than 14 d, free intra-abdominal air, or endoscopically-proved extensive gangrene.
Indications
- Surgery is not the first-line treatment option for patients with ischemic colitis. Surgery is usually reserved for patients with either:[1][2]
- Sepsis
- Persistent fever and leukocytosis
- Peritoneal irritation
- Protracted pain
- Diarrhea or bleeding
- Protein-losing colopathy for more than 14 days
- Free intra-abdominal air
- Endoscopically-proven extensive gangrene
Surgery
- Surgery for ischemic colitis is as follows:
- 20% of patients with acute ischemic colitis will require surgery with an associated mortality rate of up to 60%.
- Laparotomy confirms the diagnosis and all affected bowel is resected.
- Extent of resection should be guided by the distribution of disease seen on preoperative studies
- Resected segment should be examined in the operating room for mucosal injury.
Contraindications
References
- ↑ Baixauli J, Kiran RP, Delaney CP (2003). "Investigation and management of ischemic colitis". Cleve Clin J Med. 70 (11): 920–1, 925–6, 928-30 passim. PMID 14650467.
- ↑ Theodoropoulou, Αngeliki; Κoutroubakis, Ioannis E (2008). "Ischemic colitis: Clinical practice in diagnosis and treatment". World Journal of Gastroenterology. 14 (48): 7302. doi:10.3748/wjg.14.7302. ISSN 1007-9327.