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James C Andrews - One of the best experts on this subject based on the ideXlab platform.
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Ischemic Colitis an unusual case of inferior mesenteric arteriovenous fistula causing venous hypertension report of a case
Diseases of The Colon & Rectum, 2008Co-Authors: Dan R Metcalf, Santhat Nivatvongs, James C AndrewsAbstract:Mesenteric arteriovenous fistulas are a rare entity. Those involving the inferior mesenteric artery are exceptionally rare with only 13 cases reported in the English literature,1,2 of which only one has been associated with Ischemic Colitis. Ischemic Colitis is a well-recognized clinical entity that typically occurs spontaneously in elderly patients and is not associated with a specific clinical presentation.3 We report a case of Ischemic Colitis caused by venous hypertension associated with a congenital inferior mesenteric arteriovenous fistula. To our knowledge, this is the first reported case of a mesenteric arteriovenous fistula causing Ischemic Colitis in a patient without previous gastrointestinal surgery or trauma.
Baongoc Nguyen - One of the best experts on this subject based on the ideXlab platform.
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preservation of pelvic perfusion with iliac branch devices does not decrease Ischemic Colitis compared with hypogastric embolization in endovascular abdominal aortic aneurysm repair
Journal of Vascular Surgery, 2020Co-Authors: Brandon Glousman, Anton N Sidawy, Robyn A Macsata, Sara L Zettervall, Benjamin K Lee, Richard Amdur, Baongoc NguyenAbstract:Abstract Objective Ischemic Colitis is a rare but devastating complication of endovascular repair of infrarenal abdominal aortic aneurysms. Although it is rare (0.9%) in standard endovascular aneurysm repair (EVAR), the incidence increases to 2% to 3% in EVAR with hypogastric artery embolization (HAE). This study investigated whether preservation of pelvic perfusion with iliac branch devices (IBDs) decreases the incidence of Ischemic Colitis. Methods We used the targeted EVAR module in the American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing EVAR of infrarenal abdominal aortic aneurysm from 2012 to 2017. The cohort was further stratified into average-risk and high-risk groups. Average-risk patients were those who underwent elective repair for sizes of the aneurysms, whereas high-risk patients were repaired emergently for indications other than asymptomatic aneurysms. Within these groups, we examined the 30-day outcomes of standard EVARs, EVAR with HAE, and EVAR with IBDs. The primary outcome was the incidence of Ischemic Colitis. Secondary outcomes included mortality, major organ dysfunction, thromboembolism, length of stay, and return to the operating room. The χ2 test, Fisher exact test, Kruskal-Wallis test, and multivariate regression models were used for data analysis. Results There were 11,137 patients who had infrarenal EVAR identified. We designated this the all-risk cohort, which included 9263 EVAR, 531 EVAR-HAE, and 1343 EVAR-IBD procedures. These were further stratified into 9016 cases with average-risk patients and 2121 cases with high-risk patients. In the average-risk group, 7482 had EVAR, 411 had EVAR-HAE, and 1123 had EVAR-IBD. In the high-risk group, 1781 had EVAR, 120 had EVAR-HAE, and 220 had EVAR-IBD. There was no significant difference in 30-day outcomes (including Ischemic Colitis) between EVAR, EVAR-HAE, and EVAR-IBD in the all-risk and high-risk groups. In the average-risk cohort, EVAR-HAE was associated with a higher mortality rate than EVAR (2.2% vs 1.0%; adjusted odds ratio, 2.58; P = .01). Although EVAR-IBD was not superior to EVAR-HAE in 30-day mortality, major organ dysfunction, or Ischemic Colitis in this average-risk cohort, EVAR-IBD exhibited a trend toward lower mortality compared with EVAR-HAE in this cohort, but it was not statistically significant (1.0% vs 2.2%; adjusted odds ratio, 0.42; P = .07). Conclusions Ischemic Colitis is a rare complication of EVAR. HAE does not appear to increase the risk of Ischemic Colitis, and preservation of pelvic perfusion with IBDs does not decrease its incidence. Although HAE is associated with significantly higher mortality than standard EVAR in average-risk patients, the preservation of pelvic perfusion with IBDs does not appear to improve mortality over HAE.
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inferior mesenteric artery replantation does not decrease the risk of Ischemic Colitis after open infrarenal abdominal aortic aneurysm repair
Journal of Vascular Surgery, 2019Co-Authors: Jinny Lu, Robyn Macsata, Darshan Patel, Alexander Yang, John Ricotta, Richard L Amdur, Anton N Sidawy, Baongoc NguyenAbstract:Abstract Background Ischemic Colitis after an open abdominal aortic aneurysm (AAA) repair remains a serious complication with a nationally reported rate of 1% to 6% in elective cases and up to 60% after an aneurysmal rupture. To prevent this serious complication, inferior mesenteric artery (IMA) replantation is performed at the discretion of the surgeon based on his or her intraoperative findings, despite the lack of clear evidence to support this practice. The purpose of this study was to determine whether replantation of the IMA reduces the risk of Ischemic Colitis and improves the overall outcome of AAA repair. Methods Patients who underwent open infrarenal AAA repair were identified in the multicenter American College of Surgeons National Surgical Quality Improvement Program Targeted AAA Database from 2012 to 2015. Emergency cases, patients with chronically occluded IMAs, ruptured aneurysms with evidence of hypotension, and patients requiring visceral revascularization were excluded. The remaining elective cases were divided into two groups: those with IMA replantation (IMA-R) and those with IMA ligation. We measured the 30-day outcomes including mortality, morbidity, and perioperative outcomes. A multivariable logistic regression model was used for data analysis, adjusting for clinically relevant covariates. Results We identified 2397 patients who underwent AAA repair between 2012 and 2015, of which 135 patients (5.6%) had Ischemic Colitis. After applying the appropriate exclusion criteria, there were 672 patients who were included in our study. This cohort was divided into two groups: 35 patients with IMA-R and 637 patients with IMA ligation. There were no major differences in preoperative comorbidities between the two groups. IMA-R was associated with increased mean operative time (319.7 ± 117.8 minutes vs 242.4 ± 109.3 minutes; P Conclusions These data suggest that IMA-R is not associated with protection from Ischemic Colitis after open AAA repair. The role of IMA-R remains to be identified.
Zain Kulairi - One of the best experts on this subject based on the ideXlab platform.
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stercoral Colitis complicated with Ischemic Colitis a double edge sword
BMC Gastroenterology, 2017Co-Authors: Maliha Naseer, Jenil Gandhi, Noor Chams, Zain KulairiAbstract:Stercoral Colitis is a rare inflammatory process involving the colonic wall secondary to fecal impaction with high morbidity and mortality; especially if complicated with Ischemic Colitis, stercoral ulcer formation and subsequent perforation. There are several case reports published on abdominal perforation resulting from stercoral Colitis. However, stercoral Colitis complicated by Ischemic Colitis is rare. The purpose of this case report is to describe the potential challenges in the diagnosis and management of stercoral Colitis with Ischemic Colitis. An 87 years old male with history of chronic constipation presents with severe abdominal pain to the emergency department. The patient was hemodynamically stable. On physical examination, the abdomen was mildly distended with moderate tenderness. Lab work was significant for leukocytosis and lactic acidosis. Abdominal CT scan revealed large amount of retained stool in the colon, bowel wall thickening and infiltration of peri-colonic fat, which were suggestive for stercoral Colitis. Patient was started on IV fluids and antibiotics. He was given an enema, followed by laxative and manual disimpaction of stool. Colonoscopy was performed and biopsies were obtained. Tissue biopsy was significant for focal active Colitis with regenerative glandular changes and neural hyperplasia. Elevated lactic acid level secondary to ischemia of the bowel wall with CT scan findings aid in establishing the diagnosis of stercoral Colitis complicated with Ischemic Colitis. Urgent treatment with laxatives and fecal disimpaction is indicated to prevent perforation and peritonitis.
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Stercoral Colitis complicated with Ischemic Colitis: a double-edge sword
BMC, 2017Co-Authors: Maliha Naseer, Jenil Gandhi, Noor Chams, Zain KulairiAbstract:Abstract Background Stercoral Colitis is a rare inflammatory process involving the colonic wall secondary to fecal impaction with high morbidity and mortality; especially if complicated with Ischemic Colitis, stercoral ulcer formation and subsequent perforation. There are several case reports published on abdominal perforation resulting from stercoral Colitis. However, stercoral Colitis complicated by Ischemic Colitis is rare. The purpose of this case report is to describe the potential challenges in the diagnosis and management of stercoral Colitis with Ischemic Colitis. Case presentation An 87 years old male with history of chronic constipation presents with severe abdominal pain to the emergency department. The patient was hemodynamically stable. On physical examination, the abdomen was mildly distended with moderate tenderness. Lab work was significant for leukocytosis and lactic acidosis. Abdominal CT scan revealed large amount of retained stool in the colon, bowel wall thickening and infiltration of peri-colonic fat, which were suggestive for stercoral Colitis. Patient was started on IV fluids and antibiotics. He was given an enema, followed by laxative and manual disimpaction of stool. Colonoscopy was performed and biopsies were obtained. Tissue biopsy was significant for focal active Colitis with regenerative glandular changes and neural hyperplasia. Conclusion Elevated lactic acid level secondary to ischemia of the bowel wall with CT scan findings aid in establishing the diagnosis of stercoral Colitis complicated with Ischemic Colitis. Urgent treatment with laxatives and fecal disimpaction is indicated to prevent perforation and peritonitis
Ciro Famulari - One of the best experts on this subject based on the ideXlab platform.
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Ischemic Colitis following colonoscopy in a systemic lupus erythematosus patient report of a case
Diseases of The Colon & Rectum, 2005Co-Authors: A Versaci, Antonio Macri, Giuseppe Scuderi, Sebastiano Bartolone, Luigi Familiari, Tommaso Lupattelli, Ciro FamulariAbstract:Ischemic Colitis is an uncommon complication in patients with systemic lupus erythematosus but may be precipitated by colonoscopy. A 43-year-old female with systemic lupus erythematosus under treatment with immunosuppressive drugs and prednisone was submitted to colonoscopy because of a change in bowel habit. Apart from the presence of a small metaplastic polyp, colonoscopy showed only a few erythematosus areas in the sigma and left colon. Four hours after colonoscopy, the patient developed lower colic abdominal pain and mucous diarrhea followed by rectal bleeding from Ischemic Colitis. The patient was successfully treated with fluids, spasmolytic drugs, sodic heparin, antibiotics and enteral feeding. Awareness of the risk of this potential complication, secondary to colonoscopy, in patients with connective tissue disorders may lead to a prompt diagnosis and effective treatment, with a successful outcome.
Dan R Metcalf - One of the best experts on this subject based on the ideXlab platform.
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Ischemic Colitis an unusual case of inferior mesenteric arteriovenous fistula causing venous hypertension report of a case
Diseases of The Colon & Rectum, 2008Co-Authors: Dan R Metcalf, Santhat Nivatvongs, James C AndrewsAbstract:Mesenteric arteriovenous fistulas are a rare entity. Those involving the inferior mesenteric artery are exceptionally rare with only 13 cases reported in the English literature,1,2 of which only one has been associated with Ischemic Colitis. Ischemic Colitis is a well-recognized clinical entity that typically occurs spontaneously in elderly patients and is not associated with a specific clinical presentation.3 We report a case of Ischemic Colitis caused by venous hypertension associated with a congenital inferior mesenteric arteriovenous fistula. To our knowledge, this is the first reported case of a mesenteric arteriovenous fistula causing Ischemic Colitis in a patient without previous gastrointestinal surgery or trauma.
