Analysis Of Ischemic Colitis On Clinical Features And Comparison With Ulcerative Colitis

Objective:To further enhance the understanding of ischemic colitis(IC)and facilitate diagnosis and differential diagnosis with ulcerative colitis(UC),we retrospective analyzed medical records of patients with IC patients and UC patients admitted to the Affiliated of North Sichuan Medical College.Methods:The present study was a retrospective analysis of records of 124 IC and 107 UC patients from 2011 to 2019 in the Affiliated of North Sichuan Medical College.Basic data collection included demographic feature,risk factors,clinical presentation,laboratory examination and colonoscopy result.We analyzed the clinical features of IC and compared it with UC.Result:1.Patient's demographic feature of ischemic colitis.IC patients included 124 patients with 42 males and 82 females,whose age ranged from 27 to 85 years and the mean age was 61.27±11.44 years.Patients with less than 50 years,more than 50,between 50 and 59,more than 60 contained the number of 22,102,29,73 respectively.2.Complicated disease.Most of cases were combined with other disease.84 patients(67.74%)were related to one or more risk factors of atherosclerotic disease,31 patients with a history of abdominal surgery,20 patients with constipation,15 patients with chronic obstructive pulmonary disease,1 patient with acute left heart failure,6 patients with psoriasis.Clinical characteristics:Among 124 IC,51(41.13%)patients occurred in warm season and 73(58.87%)patients happened in cold season;111(89.52%)patients with acute onset and 13(10.48%)patients with acute exacerbation of chronic onset were included in our study.118(95.16%)patients had sudden cramping,abdominal pain and an urgent desire to defecate.There were 116(93.55%)patients with blood stool.Rectal bleeding occurred successively after abdominal pain in 110 patients(88.71%),included 54(43.55%)patients who presented abdominal pain-yellow stool in turn.8(6.45%)patients showed only abdominal pain.Blood stool was the only clinical symptom in 6 patients(4.84%).In terms of physical signs,the main positive findings were left abdominal and lower abdominal tenderness in 72 patients(58.06%)and rebound pain in 14 patients(11.29%).Auxiliary examination results:124 IC patients underwent colonoscopy,and the lesion sites were mainly located in splenic curvature,sigmoid colon and descending colon,involving one of three or more sites in 111 patients(89.52%)The rectum was involved in 9 patients,transverse colon in 47 patients,ascending colon in 21 patients and cecum in 7 cases.Colonoscopy result mainly presented as redness erosion,ooze blood,ulcer,white moss,lumen stenosis.Besides,surroundings mucous membrane boundary was clear.Among the 124 IC patients,30 had abdominal CT examination,main signs included thickening of the colon wall,edema and uneven enhancement with different degree of roughness in the surrounding fat space in 24 patients,and abdominal and pelvic effusion in 11 patients.27 patients underwent CTA examination,of which 15(55.6%)showed atherosclerotic plaques of the abdominal aorta and its branches.Results of outcome and long-term follow-up:122 of the 124 IC patients improved and were discharged from hospital,and 2 patients had poor treatment effect and asked to be discharged from hospital.Sixty patients were followed up by telephone.The follow-up rate was 48.39%and the follow-up time was from 2 months to 9 years.5 patients(8.33%)had definite recurrence?Comparison of IC and UC:?The age of IC group was significantly higher than UC(P<0.05).?IC combined with hypertension,diabetes,coronary heart disease,hyperlipidemia,chronic constipation and chronic obstructive pulmonary disease were significantly higher than those in the UC group(P<0.05).IC was presented as more acute and short course,while UC was slow and long course;the IC group had a higher incidence of abdominal pain,pure blood stool,nausea and vomiting,and abdominal distension while the UC group had a higher incidence of diarrhea,mucus blood stool,and tenesmus,with statistically significant differences between the two groups(P<0.05).WBC,Hb,Mean corpuscular volume(MCV),Mean corpuscular hemoglobin(MCH)and Mean corpuscular hemoglobin concentration(MCHC)in the IC group were all higher than those in the UC group,with statistically significant differences(P<0.05).The UC group had higher incidence of rough mucous membrane particles and blurred vascular texture on the colonoscopy examination than IC group.(P<0.05).IC showed segmental distribution and clear boundaries with surrounding mucosa,while UC showed diffuse and continuous distribution.The incidence of involving rectum and sigmoid colon in UC group was significantly higher than that in IC group(P<0.05).About pathology examination,more patients in UC group presented as crypt inflammation or crypt abscess,necrosis or erosion than patients in IC group(P<0.05).Conclusions:1.Elderly women are the high-risk group of IC.Hypertension,diabetes,hyperlipidemia,chronic obstructive pulmonary disease,constipation,abdominal surgery history may be closely related to IC;Cold seasons may be a trigger factor for IC.2.Acute onset may be one of the important clinical features of IC;Acute abdominal pain,an urgent desire to defecate and rectal bleeding especially sudden cramping,abdominal pain followed by rectal bleeding may be one of IC's relatively specific clinical manifestations.3.Colonoscopy is an important means to diagnose IC;Microscopically,the main manifestations were hyperemia,edema,erosion,bleeding and ulcer,etc.,and the lesion was mostly clear with the surrounding mucosa.It mainly involved descending colon,sigmoid colon and splenic flexion.Pathological examination was lack of specificity.4.CT examination has certain reference value for IC diagnosis;CTA is helpful for the detection of atheromatous plaques in peritoneal blood vessels.It can directly indicate the presence of atherosclerosis,and may facilitate the diagnosis of IC.Abdominal X-ray examination may be useful for differential diagnosis of acute abdomen pain.5.IC has good overall treatment effect,low recurrence rate and good prognosis.6.IC tends to occur in elderly women,while UC tends to occur in middle-aged and young people.The former may be closely related to hypertension,diabetes,hyperlipidemia,chronic obstructive pulmonary disease,constipation,and abdominal surgery history,but has no significant relationship with UC.7.Acute onset,sudden cramping,abdominal pain and rectal bleeding are the important clinical characteristics of IC,while slow onset,mucus blood stool and tenesmus are the clinical characteristics of UC.PLT may have certain clinical value in distinguishing active UC from IC.MCV,MCH,MCHC may have clinical significance between distinguishing UC and IC.Rectal involvement and diffuse and continuous distribution of the lesions under colonoscopy were observed,and the manifestations of the lesions were mucous granule and vascular texture blur,which may be important features of UC as distinct from IC under colonoscopy.The histological manifestations of crypt inflammation or crypt abscess may be important pathological features of UC as distinct from IC.