Kosin Med J.  2013 Dec;28(2):99-106. 10.7180/kmj.2013.28.2.99.

Characteristics of Clinical Features between Isolated Left Side Ischemic Colitis and Non-Isolated Left Side Ischemic Colitis

• Heo JJ
• Kim HH
• Song JY
• Park SJ
• Park MI
• Moon W

• KMID: 1993567
• DOI: http://doi.org/10.7180/kmj.2013.28.2.99

Abstract

OBJECTIVES
Compared with all other patterns, isolated right colon ischemia has been found to be more associated with coronary artery disease and a poor prognosis. However, there has been no research on comparing isolated left side ischemic colitis (ILIC) and non-ILIC with vascular assessment. The aim of the present study was to evaluate the clinical and laboratory findings between these two different forms of ischemic colitis (IC).
METHODS
We retrospectively investigated differences in clinical features, course, and mesenteric vascular (superior mesenteric artery, SMA; inferior mesenteric artery, IMA) findings between ILIC and non-ILIC patients who were hospitalized at Kosin University Gospel Hospital from 2004 to 2010.
RESULTS
Our study population comprised 221 patients, all of whom met our entry criteria of biopsy-proven or -compatible IC. Of the 221 patients, 46 (20.8%) had non-ILIC. Congestive heart failure and hypercholesterolemia were more frequently observed in the non-ILIC group (P = 0.003 and P = 0.020, respectively). SMA atherosclerosis and SMA stenosis were more frequently observed in the non-ILIC group (P = 0.006 and P = 0.001, respectively). Recovery periods were longer in the non-ILIC group (P = 0.039), and mortality was lower in the ILIC group (6.9% vs. 17.3%, P = 0.026).
CONCLUSIONS
ILIC has favorable outcomes compared with non-ILIC. Furthermore, non-ILIC showed a close relationship with SMA atherosclerosis and SMA stenosis, which should be investigated carefully in the clinical field.

Keyword

Atherosclerosis; Ischemic colitis; Stenosis; Superior mesenteric artery

MeSH Terms

Atherosclerosis
Colitis, Ischemic*
Colon
Constriction, Pathologic
Coronary Artery Disease
Heart Failure
Humans
Hypercholesterolemia
Ischemia
Mesenteric Arteries
Mesenteric Artery, Inferior
Mesenteric Artery, Superior
Mortality
Prognosis
Retrospective Studies

Figure

• 

  Fig. 1. Severity of ischemic colitis assessed by colonoscopy. (A) Mild ischemic colitis is defined as segmental hyperemic erosive mucosal change without deep ulceration. (B) Moderate ischemic colitis is defined as hyperemic mucosal change and focal ulceration with severe edema. (C) Severe ischemic colitis is defined as extensive exfoliation of colonic mucosa combined with deep ulceration or gangrene.

• 

  Fig. 2. Kaplan–Meier survival curve comparing ILIC with non-ILIC. Mortality is lower in the ILIC group than non-ILIC group (6.9% vs. 17.3%, P = 0.026, hazard ratio = 0.286, 95% confidence interval = 0.095-0.855). ILIC, isolated left side ischemic colitis.

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