Retrospective Analysis Of Ischemic Bowel Disease On Clinical Features

Background and ObjectivesIschemic bowel disease comprises a spectrum of intestinal ischemic injury caused by inadequate blood perfusion or obstructed backflow of intestine. It has been classified into three categories, acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI) and ischemic colitis(IC).Colonic ischemia is the most common. Ischemic bowel disease can also be divided into acute ischemic bowel disease and chronic ischemic bowel disease. It is more common in the elderly. Because of its atypical clinical manifestations, the diagnosis is not clear sometimes and misdiagnosis rate is high. As a result, its diagnosis is delayed and prognosis is poor. With the aging of population increased, the incidence of ischemic bowel disease has also increased. This paper aims to raise awareness and reduce the misdiagnosis rate and mortality of ischemic bowel disease by the analysis and comparison of different types of ischemic bowel disease in clinical characteristics, diagnosis and treatment.Methods92 cases of ischemic bowel disease, which were diagnosed in digestion medicine of three hospitals, namely, Qilu Hospital from January 2009 to November 2015, Provincial Hospital from January 2009 to November 2015 and the second hospital of Shandong University from January 2003 to November 2015,were collected to make a retrospective analysis. The extracted data contain Sex, age, clinical manifestations, past history, personal history, laboratory tests, imaging and colonoscopy, treatment and medication, hospitalization and prognosis.Results1、In 92 patients, there are 49 cases of ischemic colitis (53.26%),followed by acute mesenteric ischemia (29.35%); The number of patients over 60 years old is 63 (68.48%); The proportion of men and women is 1:1.24.Compared with patients with acute mesenteric ischemia, females are more common in ischemic colitis.2、 Clinical presentations include abdominal pain (91.30%), gastrointestinal bleeding (50%), diarrhea, abdominal distension and son on. In acute mesenteric ischemia group,100%of patients have abdominal pain and 29.63%of patients have gastrointestinal bleeding. And in ischemic colitis group, the percentages are 83.67% and 75.51%。Upper abdominal pain is more prevailing in acute mesenteric ischemia while ischemic colitis is generally followed by lower abdominal pain and gastrointestinal bleeding.In chronic mesenteric ischemia, periumbilical and upper abdominal pain are common,56.25%of patients have lost weight.3, The major comorbidities are hypertension (50%), diabetes (20.65%), coronary heart disease (21.74%).Some patients underwent endoscopic examination or abdominal surgery before and some persons took aspirin formerly. Smoking is common in chronic mesenteric ischemia. There is no difference between acute mesenteric ischemia group and ischemic colitis group in comorbidities except cirrhosis of the liver which is more common in the former group.4、 Laboratory examination shows that 34.78%of white blood cell count increases,26.09%of hemoglobin value decreases,45.45%of D-dimer increases. The prolonged prothrombin time is more common in acute mesenteric ischemia group than ischemic colitis group.5、Positive rate of CT scan in acute mesenteric ischemia group is 60%and in ischemic colitis group it is 52%. Positive rate of CTA in mesenteric ischemia group is 81.82%which is higher than the rate of ischemic colitis group, with statistical significance (P　= 0.003). Lesions in superior mesenteric artery and superior mesenteric vein are usually seen in acute mesenteric ischemia group. In acute mesenteric ischemia, lesions are always located in superior mesenteric artery and vein, while in chronic mesenteric ischemia superior mesenteric artery and aortic artery are affected. In ischemic colitis group, descending colon (46.51%) and sigmoid (51.16%) are mainly affected areas.6、91 cases were treated with conservative treatment and only 1 case underwent surgery.89 cases improved and discharged after treatment,3 patients died.ConclusionsIschemic bowel disease often occurs in elderly. When elderly persons especially those with hypertension, have acute abdominal pain, gastrointestinal bleeding and other symptoms of acute abdomen, ischemic bowel disease should be considered. Among them, acute mesenteric ischemia and ischemic colitis are more seen. There are some significant differences between the two groups in gender, location of abdominal pain, gastrointestinal bleeding, liver cirrhosis, prolonged prothrombin time and the positive rate of CTA. Fewer patients with chronic mesenteric ischemia can be seen and most of them have weight loss. Smoking and diabetes are main risk factors for chronic mesenteric ischemia. In addition, the superior mesenteric artery is usually affected both in acute mesenteric ischemia and chronic mesenteric ischemia.Timely medical treatment can generally bring better prognosis. Antiplatelet, anticoagulant and thrombolytic therapy should be considered in acute and chronic mesenteric ischemia or abnormal coagulation state. Besides, serious illness may be treated with interventional therapy or surgery.