Margolis I B, Faro R S, Howells E M, Organ C H
Ann Surg. 1979 Jul;190(1):40-4. doi: 10.1097/00000658-197907000-00009.
Ischemic colitis has been previously described in three forms: transient, strictured, and gangrenous. A fourth form of presentation in the elderly is characterized by signs of an acute abdomen, massive colonic dilatation, and systemic toxicity. Bloody diarrhea may be seen prior to the onset of dilatation. Ischemia should be considered as an etiologic factor in "colitis" in the elderly patient with segmental dilatation particularly if it follows a "low flow state." The rectum is usually uninvolved. Barium enema may confirm segmental involvement and later demonstrate stricture. Three patients with ischemic megacolon are presented. The diagnosis was suspected preoperatively in only one. In contrast to ulcerative colitis, these patients show a more abrupt onset and run a fulminant course. In patients who recover, there is lower relapse rate than young patients with ulcerative colitis. When resection is indicated, all attempts should be made to spare the rectum. Loop ileostomy and decompressive colostomy offer an excellent temporizing measure to assist the patient through the acute phase of the illness.
短暂性、狭窄性和坏疽性。老年人的第四种表现形式的特征是急腹症体征、大量结肠扩张和全身中毒。在扩张发作之前可能会出现血性腹泻。对于出现节段性扩张的老年患者，尤其是在“低流量状态”之后发生的“结肠炎”，应将缺血视为病因之一。直肠通常未受累。钡剂灌肠可证实节段性受累，并随后显示狭窄。本文介绍了三例缺血性巨结肠患者。术前仅一例被怀疑诊断。与溃疡性结肠炎不同，这些患者起病更急，病程凶险。康复的患者复发率低于溃疡性结肠炎的年轻患者。当需要进行切除时，应尽一切努力保留直肠。袢式回肠造口术和减压结肠造口术是极好的临时措施，可帮助患者度过疾病的急性期。
