The outcomes and prognostic factors of surgical treatment for ischemic colitis: what can we do for a better outcome?

BACKGROUND/AIMS: Surgical treatment is mandatory for severe ischemic colitis, but morbidity and mortality are high. We evaluated the outcomes and prognostic factors of surgical treatment for ischemic colitis.

METHODOLOGY

Forty-nine consecutive patients (M:F, 26:23, median, 63 years), who underwent surgery for ischemic colitis by single surgeon, had been recruited prospectively and retrospectively analyzed.

RESULTS

The causes of ischemia were vascular occlusions in 35 (71.4%). Thirty-seven (75.5%) patients had coexisting chronic medical problems. Emergency operation was performed in 40 (81.6%). Ischemic regions were right colon in 20 (40.8%), left colon in 19 (38.8%), and whole colon in 9 (18.4%). Resection with stoma formation was performed in 29 (59.2%) and primary anastomosis in 19 (38.8%). Postoperative morbidity occurred in 42 (85.7%) and mortality in 22 (44.9%). Univariate analysis showed that abdominal pain with peritoneal irritation signs, systemic inflammatory response, severe systemic hypotension, cardiovascular disease, vasoactive drug, emergency operation, and stoma formation were unfavorably associated with morbidity and/or mortality. Preoperative severe systemic hypotension was the only significant risk factor of mortality in multivariate analysis.

CONCLUSIONS

Morbidity and mortality remained high in surgery for ischemic colitis. As preoperative systemic hypotension was the most important, early surgical treatment before the disease being deteriorated is mandatory.