Colon Involvement in Necrotizing Pancreatitis
| Autor: | Megan E. Nicolas, Thomas K. Maatman, Michael G. House, Attila Nakeeb, Nicholas J. Zyromski, Christian M. Schmidt, Hayder H Al-Azzawi, Kyle A. Lewellen, Eugene P. Ceppa, Alexandra M. Roch |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Fulminant Fistula Perforation (oil well) Gastroenterology Coronary artery disease Clostridium Difficile Colitis Colonic Diseases 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Humans Medicine Retrospective Studies Pancreatitis Acute Necrotizing business.industry Incidence Incidence (epidemiology) Odds ratio Middle Aged medicine.disease Respiratory failure 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology Surgery business |
| Zdroj: | Annals of Surgery. 275:568-575 |
| ISSN: | 1528-1140 0003-4932 |
| DOI: | 10.1097/sla.0000000000004149 |
| Popis: | Objective To investigate the incidence, risk factors, and outcomes of colon involvement in patients with necrotizing pancreatitis. Summary/background data Necrotizing pancreatitis is characterized by a profound inflammatory response with local and systemic implications. Mesocolic involvement can compromise colonic blood supply leading to ischemic complications; however, few data exist regarding this problem. We hypothesized that the development of colon involvement in necrotizing pancreatitis (NP) negatively affects morbidity and mortality. Methods Six hundred forty-seven NP patients treated between 2005 and 2017 were retrospectively reviewed to identify patients with colon complications, including ischemia, perforation, fistula, stricture/obstruction, and fulminant Clostridium difficile colitis. Clinical characteristics were analyzed to identify risk factors and effect of colon involvement on morbidity and mortality. Results Colon involvement was seen in 11% (69/647) of NP patients. Ischemia was the most common pathology (n = 29) followed by perforation (n = 18), fistula (n = 12), inflammatory stricture (n = 7), and fulminant C difficile colitis (n = 3). Statistically significant risk factors for developing colon pathology include tobacco use (odds ratio (OR), 2.0; 95% confidence interval (CI), 1.2-3.4, P = 0.009), coronary artery disease (OR, 1.9; 95% CI, 1.1-3.7; P = 0.04), and respiratory failure (OR, 4.7; 95% CI, 1.1-26.3; P = 0.049). When compared with patients without colon involvement, NP patients with colon involvement had significantly increased overall morbidity (86% vs 96%, P = 0.03) and mortality (8% vs 19%, P = 0.002). Conclusion Colon involvement in necrotizing pancreatitis is common; clinical deterioration should prompt its evaluation. Risk factors include tobacco use, coronary artery disease, and respiratory failure. Colon involvement in necrotizing pancreatitis is associated with substantial morbidity and mortality. |
| Databáze: | OpenAIRE |
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