title: Colon ischemia: Right-sided colon involvement has a different presentation, etiology and worse outcome. A large retrospective cohort study in histology proven patients.
abstract: BACKGROUND
  Colon ischemia (CI), is generally considered a non-occlusive mesenteric ischemia disorder that usually runs a benign course, but right-sided involvement (RCI) has been associated with worse outcome. The poor outcome of RCI has been associated with comorbidity, but more recently also with occlusions of the mesenteric arteries. We performed a retrospective analysis of a large cohort of CI-patients to assess differences in presentation, etiology, and comorbidity between right-sided colon ischemia (RCI) and non-right-sided colon ischemia (NRCI), and their relation to outcome.
  
  
  METHODS
  We performed a retrospective cohort study in two centers from 2000 to 2011 for CI and analyzed clinical presentation, etiology, treatment and outcome. Diagnosis was based on full colonoscopy and/or surgical findings and confirmed by histopathology.
  
  
  RESULTS
  239 patients were included (mean age 69, 52% female). RCI was found in 48% and NRCI in 52%. Patients with NRCI presented more often with rectal bleeding (87% vs. 45%; p<0.001). In RCI more nausea (58% vs. 39%; p=0.013), weight loss (56% vs. 19%; p<0.001), paralytic ileus (32% vs. 18%; p=0.018) and peritoneal signs (27% vs. 7%; p<0.001) was observed compared to NRCI. The cause of CI was more often idiopathic in NRCI (46% vs. 26%; p=0.002); an occlusive cause was seen more often in RCI (26.3 vs 2.4%, p<0.0001). RCI patients had longer hospital stay (15 vs. 8 days, p<0.001), need for surgery (61% vs. 34%, p<0.001), and trend toward higher 30-day in-hospital mortality (20% vs. 12%, p=0.084).
  
  
  CONCLUSIONS
  RCI ischemia has different etiology, presentation, and outcome. The series shows a high proportion of - treatable - vessel occlusion. It reinforces the advice to perform CT angiography in RCI as means to improve its poor outcome.
authors.affiliation: Department of Gastroenterology, Medical Spectrum Twente, Enschede, The Netherlands.
authors.forename: Lotte B
authors.initials: LB
authors.lastname: Ten Heggeler
authors.affiliation: Department of Gastroenterology, Medical Spectrum Twente, Enschede, The Netherlands; Department of Gastroenterology, Isala Clinics, Zwolle, The Netherlands.
authors.forename: Lisette J H
authors.initials: LJ
authors.lastname: van Dam
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Alderina
authors.initials: A
authors.lastname: Bijlsma
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Marijn C
authors.initials: MC
authors.lastname: Visschedijk
authors.affiliation: Department of Vascular Surgery, Medical Spectrum Twente, Enschede, The Netherlands.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Geelkerken
authors.affiliation: Department of Gastroenterology, Isala Clinics, Zwolle, The Netherlands.
authors.forename: Maarten A C
authors.initials: MA
authors.lastname: Meijssen
authors.affiliation: Department of Gastroenterology, Medical Spectrum Twente, Enschede, The Netherlands; Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: j.kolkman@mst.nl.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Kolkman
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003106:Colon / Q000473:pathology*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis*; D008297:Male; D065666:Mesenteric Ischemia / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Abdominal pain; Angiography; CTA; Colon; Ischemia; Mesenteric; Rectal bleeding; Stenosis