Real-world multicentre experience of the pathological features of colonic ischaemia and their relationship to symptom duration, disease distribution and clinical outcome.

Autor: Fenster M; Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA., Feuerstadt P; Yale University School of Medicine, New Haven, Connecticut, USA.; Gastroenterology Center of Connecticut, Hamden, Connecticut, USA., Brandt LJ; Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.; Division of Gastroenterology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA., Mansoor MS; Department of Internal Medicine, Yale-New Haven Hospital, New Haven, CT, USA., Huisman T; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Aroniadis OC; Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.; Division of Gastroenterology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
Jazyk: angličtina
Zdroj: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2018 Dec; Vol. 20 (12), pp. 1132-1141. Date of Electronic Publication: 2018 Jul 20.
DOI: 10.1111/codi.14323
Abstrakt: Aim: To determine the pathological features of colonic ischaemia (CI) and their relationship to symptom duration, disease distribution and clinical outcome in a real-world, clinical setting.
Method: A retrospective, multicentre chart review was performed in patients diagnosed with CI at Montefiore Medical Center (January 2005 to July 2015), and Yale-New Haven Hospital (January 2005 to June 2010). Patients were included if clinical presentation, colonoscopic findings and colonic pathology were all consistent with CI.
Results: Six hundred and sixteen patients with pathologically proven CI were included. Common pathological findings included inflammation (51.1%), ulceration (38.2%), fibrosis (26.0%) and necrosis (20.4%). Infarction and ghost cells were seen in 1.6% and 0.2% of cases, respectively. There was a significant relationship between symptom duration and hyalinization of the lamina propria (P = 0.05) and cryptitis/crypt abscesses (P = 0.01). Patients with isolated right CI (IRCI) were more likely than patients with isolated left CI (ILCI) to exhibit necrosis (P < 0.01), cryptitis/crypt abscess (P < 0.01) and inflammation (P = 0.03). Patients with poor outcomes were more likely to exhibit necrosis (P < 0.01) and capillary fibrin thrombi (P < 0.01) and less likely to exhibit fibrosis (P < 0.01) and epithelial changes (P < 0.01).
Conclusion: CI is accompanied by a broad spectrum of pathological findings. The traditional pathognomonic findings of CI are rare and cannot be relied upon to exclude the diagnosis. Patients with IRCI and/or poor outcomes were more likely to have pathological findings of necrosis than patients who had ILCI and/or nonpoor outcomes.
(Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.)
Databáze: MEDLINE
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