title: Ischaemic colitis: indications, extent, and results of standardized emergency surgery.
abstract: BACKGROUND
  Acute ischaemic colitis can occur postoperatively, mainly after aortic surgery, or spontaneously. Surgical treatment is debated. Study aim was to describe factors related to ischaemic colitis severity, determine if postoperative and spontaneous ischaemic colitis share similar outcomes, and evaluate results of standardized management.
  
  
  METHODS
  191 consecutive cases of ischaemic colitis observed from 1997 to 2012 were retrospectively analyzed: 119 (62%) after surgery and 72 (38%) spontaneous. Colon resection was performed for endoscopic type 2 colitis with multiple organ failure, and for every type 3. Types 1 and 2 without multiple organ failure were managed nonoperatively.
  
  
  RESULTS
  Seventeen patients (9%) were managed nonoperatively, without mortality. Mortality rate after resection was 48% (84/174), within 9 days (range, 0-152). Multivariate analysis found 2 independent factors associated with postoperative death: age≥75 years and multiple organ failure. The context in which ischaemic colitis occurred was not a risk factor for mortality. Mortality rates were 51% for final type 3 (66% with multiple organ failure, 17% without), 53% for final type 2 with multiple organ failure, and 0% for type 1 or type 2 without multiple organ failure.
  
  
  CONCLUSIONS
  An aggressive surgical approach in patients with ischaemic colitis seems justified in patients with multiple organ failure and findings of severe form of ischaemia at endoscopy.
authors.affiliation: Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Moszkowicz
authors.affiliation: Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Trésallet
authors.affiliation: Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Mariani
authors.affiliation: Department of Visceral Surgery, St-Antoine Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France.
authors.forename: Jérémie H
authors.initials: JH
authors.lastname: Lefevre
authors.affiliation: Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France.
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Godiris-Petit
authors.affiliation: Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France.
authors.forename: Séverine
authors.initials: S
authors.lastname: Noullet
authors.affiliation: Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Rouby
authors.affiliation: Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France. Electronic address: fabrice.menegaux@psl.aphp.fr.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Menegaux
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D017091:Colitis, Ischemic / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012812:Sigmoidoscopy; D015996:Survival Rate; D055815:Young Adult
keywords: Aortic surgery; Colonic ischaemia; Intestinal tract; Ischaemic colitis