Halaweish Ihab, Alam Hasan B
Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Department of Surgery, University of Michigan, Ann Arbor, MI, USA
J Intensive Care Med. 2015 Dec;30(8):451-61. doi: 10.1177/0885066614534941. Epub 2014 May 22.
Severe colitis, an umbrella encompassing several entities, is one of the most common acute gastrointestinal disorders resulting in critical illness. Clostridium difficile infection is responsible for the majority of nosocomial diarrhea with fulminant C difficile colitis (CDC) carrying a high mortality. Optimal outcomes can be achieved by early identification and treatment of fulminant CDC, with appropriate surgical intervention when indicated. Ischemic colitis, on the other hand, is uncommon with a range of etiological factors including abdominal aortic surgery, inotropic drugs, rheumatoid diseases, or often no obvious triggering factor. Most cases resolve with nonsurgical management; however, prompt recognition of full-thickness necrosis and gangrene is crucial for good patient outcomes. Fulminant colitis is a severe disease secondary to progressive ulcerative colitis with systemic deterioration. Surgical intervention is indicated for hemorrhage, perforation, or peritonitis and failure of medical therapy to control the disease. Although, failure of medical management is the most common indication, it can be difficult to define objectively and requires a collaborative multidisciplinary approach. This article proposes some simple management algorithms for these clinical entities, with a focus on critically ill patients.
重症结肠炎是一个涵盖多种病症的统称，是导致危重病的最常见急性胃肠疾病之一。艰难梭菌感染是大多数医院获得性腹泻的病因，暴发性艰难梭菌结肠炎（CDC）的死亡率很高。早期识别和治疗暴发性CDC，并在必要时进行适当的手术干预，可取得最佳治疗效果。另一方面，缺血性结肠炎并不常见，其病因包括腹主动脉手术、血管活性药物、类风湿疾病等，或者往往没有明显的触发因素。大多数病例通过非手术治疗即可缓解；然而，及时识别全层坏死和坏疽对于患者的良好预后至关重要。暴发性结肠炎是继发于进行性溃疡性结肠炎并伴有全身恶化的严重疾病。出现出血、穿孔、腹膜炎以及药物治疗无法控制病情时，需进行手术干预。虽然药物治疗失败是最常见的手术指征，但很难进行客观界定，需要多学科协作的方法。本文针对这些临床病症提出了一些简单的管理算法，重点关注危重病患者。
