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News

Risk factors for fatal colonic ischemia

In the latest Scandanavian Journal of Gastroenterology, doctors show that heart failure, and recent surgery are the main risk factors of colonic infarction.

News image

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Dr Stefan Acosta and colleagues from Sweden estimated the incidence and cause-specific mortality of fatal colonic ischemia.

The team of doctors described the localization and extension of colonic infarction and quantify the risk factors associated with colonic ischemia.

The team reported that between 1970 and 1982 the autopsy rate in Malmö, Sweden, was 87%, creating the possibilities for a population-based study.

Out of 23,446 clinical autopsies, 997 cases were coded for intestinal ischemia in a database.

Cause-specific mortality ratio was about 2 per 1000 autopsies
Scandanavian Journal of Gastroenterology

In addition, the doctors analyzed 7569 forensic autopsy protocols.

In a case-control study nested in the clinical autopsy cohort, 4 colonic ischemia-free controls were identified for each fatal colonic ischemia case.

The controls were identified to evaluated risk factors, and were matched for gender, age at death, and year of death.

The doctors found that the cause-specific mortality ratio was about 2 per 1000 autopsies.

The overall incidence of autopsy-verified fatal colonic ischemia was around 2 per 100,000 person years.

The team noted that the overall incidence of autopsy-verified fatal colonic ischemia increased with age up to 23 per 100,000 person years in octogenarians.

Fatal cardiac failure, fatal valvular disease, previous stroke, and recent surgery were risk factors for fatal colonic ischemia.

The team observed narrowing or occlusion of the inferior mesenteric artery at the aortic origin in 68% of the patients.

The most common segments affected by transmural infarctions were the sigmoid, in 83%, and the descending colon in 77% of patients.

Dr Acosta's team concludes, “Heart failure, atherosclerotic occlusion or stenoses of the inferior mesenteric artery, and recent surgery were the main risk factors causing colonic hypoperfusion and infarction.”

“Segments of transmural infarctions were observed within the left colon in 94% of the patients.”

“Awareness of the diagnosis and its associated cardiac comorbidities might help to improve survival.”

Scand J Gastroenterol 2006: 41(11): 1312-9
31 October 2006

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