Pang Ning-Qi, Lim Tian-Zhi, Zhou Yuanpei, Tan Ker-Kan
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore.
Ann Coloproctol. 2018 Aug;34(4):175-179. doi: 10.3393/ac.2017.06.14.1. Epub 2018 Aug 31.
Obstructive ileocolitis is an ulcero-inflammatory condition which typically occurs in the ileum or colon proximal to an obstructing colorectal lesion. If left unresolved, it often leads to intestinal perforation. We present a matched case control study of patients with obstructive ileocolitis caused by colorectal cancer to determine if any factors can predict this condition.
This is a retrospective review of 21 patients with obstructive colorectal cancer and histologically proven obstructive ileocolitis from 2005 to 2015 matched for age and sex with 21 controls with obstructing colorectal cancer without obstructive ileocolitis.
The 21 patients with obstructive ileocolitis had a median age of 71 years (range, 52-86 years). The most common presenting symptom was abdominal pain (n = 16, 76.2%), followed by vomiting/nausea (n = 14, 66.7%) and abdominal distension (n = 12, 57.1%). Interestingly, the radiological feature of pneumatosis intestinalis was noted in only 1 case. No significant differences were observed in baseline comorbidities, clinical presentations, or tumor characteristics between the 2 groups. Patients with obstructive ileocolitis were found to have a significantly higher total leucocyte count (17.1 ± 9.4×109/L vs. 12.0 ± 6.8×109/L, P = 0.016), lower pCO2 (32.3 ± 8.2 mmHg vs. 34.8 ± 4.9 mmHg, P = 0.013), lower HCO3 (18.8 ± 4.5 mmol/L vs. 23.6 ± 2.7 mmol/L, P < 0.001), lower base excess (-6.53 ± 5.32 mmol/L vs. -0.57 ± 2.99 mmol/L, P < 0.001) and higher serum lactate levels (3.14 ± 2.19 mmol/L vs. 1.19 ± 0.91 mmol/L, P = 0.007) compared to controls. No radiological features were predictive of obstructive ileocolitis.
Patients with obstructive ileocolitis tend to present with metabolic acidosis with respiratory compensation, raised lactate, and worse leucocytosis. Radiological features are not useful for predicting this condition.
梗阻性回结肠炎是一种溃疡性炎症性疾病，通常发生在结直肠梗阻性病变近端的回肠或结肠。若不及时解决，常导致肠穿孔。我们进行了一项配对病例对照研究，以确定是否有任何因素可预测结直肠癌所致梗阻性回结肠炎。
这是一项对2005年至2015年期间21例患有梗阻性结直肠癌且经组织学证实患有梗阻性回结肠炎患者的回顾性研究，这些患者在年龄和性别上与21例患有梗阻性结直肠癌但无梗阻性回结肠炎的对照患者相匹配。
21例梗阻性回结肠炎患者的中位年龄为71岁（范围52 - 86岁）。最常见的症状是腹痛（n = 16，76.2%），其次是呕吐/恶心（n = 14，66.7%）和腹胀（n = 12，57.1%）。有趣的是，仅1例患者出现肠壁积气的放射学特征。两组患者在基线合并症、临床表现或肿瘤特征方面未观察到显著差异。与对照组相比，梗阻性回结肠炎患者的白细胞总数显著更高（17.1 ± 9.4×10⁹/L对12.0 ± 6.8×10⁹/L，P = 0.016），pCO₂更低（32.3 ± 8.2 mmHg对34.8 ± 4.9 mmHg，P = 0.013），HCO₃更低（18.8 ± 4.5 mmol/L对23.6 ± 2.7 mmol/L，P < 0.001），碱剩余更低（-6.53 ± 5.32 mmol/L对-0.57 ± 2.99 mmol/L，P < 0.001），血清乳酸水平更高（3.14 ± 2.19 mmol/L对1.19 ± 0.91 mmol/L，P = 0.007）。没有放射学特征可预测梗阻性回结肠炎。
梗阻性回结肠炎患者往往表现为伴有呼吸代偿的代谢性酸中毒、乳酸升高和更严重的白细胞增多。放射学特征对预测这种情况无用。
