Ischemic colitis can mimic a carcinoma on computed tomographic (CT) imaging or endoscopic examination. A coexisting colonic carcinoma or another potentially obstructing lesion has also been described in 20% of the cas...Ischemic colitis can mimic a carcinoma on computed tomographic (CT) imaging or endoscopic examination. A coexisting colonic carcinoma or another potentially obstructing lesion has also been described in 20% of the cases of ischemic colitis. CT scan can differentiate it from colon cancer in 75% of cases. However, colonoscopy is the preferred method for diagnosing ischemic colitis as it allows for direct visualization with tissue sampling. Varied presentations of ischemic colitis have been described as an ulcerated or submucosal mass or as a narrowed segment of colon with ulcerated mucosa on colonoscopy. Awareness and early recognition of such varied presentations of a common condition is necessary to differentiate from a colonic carcinoma, and to avoid unnecessary surgery and related complications.展开更多
Ischemic colitis accounts for 6%-18% of the causes of acute lower gastrointestinal bleeding.It is often multifactorial and more commonly encountered in the elderly.Several medications have been implicated in the devel...Ischemic colitis accounts for 6%-18% of the causes of acute lower gastrointestinal bleeding.It is often multifactorial and more commonly encountered in the elderly.Several medications have been implicated in the development of colonic ischemia.We report a case of a 54-year old woman who presented with a two-hour history of nausea,vomiting,abdominal pain,and bloody stool.The patient had recently used lubiprostone with close temporal relationship between the increase in the dose and her symptoms of rectal bleeding.The radiologic,colonoscopic and histopathologic findings were all consistent with ischemic colitis.Her condition improved without any serious complications after the cessation of lubiprostone.This is the first reported case of ischemic colitis with a clear relationship with lubiprostone(Naranjo score of 10).Clinical vigilance for ischemic colitis is recommended for patients receiving lubiprostone who are presenting with abdominal pain and rectal bleeding.展开更多
Casals et al have reported an inverse correlation between serum phosphate and body weight after administration of sodium phosphate at a dose of 60 g. Our group has already described the relationship between body weigh...Casals et al have reported an inverse correlation between serum phosphate and body weight after administration of sodium phosphate at a dose of 60 g. Our group has already described the relationship between body weight and hyperphosphatemia with these preparations, although our study was not quoted by Casals. We performed a pharmacokinetic study involving 13 volunteers who were divided into two groups on the basis of body weight： group I consisting of seven women with a median weight of 60 kg and group Ⅱ consisting of five men and one woman with a median weight of 119.2 kg. Group Ⅰdeveloped higher peak phosphate levels and maintained these levels above the subjects in Group Ⅱ for a prolonged time period despite adequate hydration being ensured with frequent monitoring of weight, fluid intake and total body weight. Our studydemonstrated that adequate hydration does not protect against the secondary effects of hyperphosphatemia. In the study by Casais et al, 66% of the study subjects were women, the correlation between serum phosphate and gender in their data also appears to be important. Women are at higher risk of acute phosphate nephropathy due to a diminished volume of distribution of the high dose of ingested phosphate. Decreased volume of distribution in women is due to diminished body weight. This is further compounded by decreased creatinine clearance in females.展开更多
Radiographical modalities have become important diagnostic tools in cases of ulcerative colitis(UC).Imaging can be used non-invasively to determine the extent of involvement,severity of disease and to detect disease-r...Radiographical modalities have become important diagnostic tools in cases of ulcerative colitis(UC).Imaging can be used non-invasively to determine the extent of involvement,severity of disease and to detect disease-related complications and extra-intestinal inflammatory bowel disease(IBD)manifestations.While abdominal X-rays and barium enemas still retain their relevance in specific clinical settings,the use of computed tomography enterography(CTE)or magnetic resonance enterography(MRE)are now used as first-line investigations to exclude active small bowel disease in IBD patients and can be utilized to detect active colonic inflammation.Additionally,CT colonography and MR colonography are emerging techniques with potential applications in UC.Ultrasonography,leukocyte scintigraphy and positron emission tomography are novel abdominal imaging modalities currently being explored for IBD interrogations.This plethora of radiological imaging options has become a vital component of UC assessments.展开更多
Background:Proctocolectomy with ileal pouch–anal anastomosis(IPAA)is the surgical procedure of choice for medically refractory ulcerative colitis and familial adenomatous polyposis.While rare,a pouch volvulus can occ...Background:Proctocolectomy with ileal pouch–anal anastomosis(IPAA)is the surgical procedure of choice for medically refractory ulcerative colitis and familial adenomatous polyposis.While rare,a pouch volvulus can occur.We aimed to determine the frequency,presentation,and management approach of pouch volvulus in patients with IPAA.Methods:A systematic search of published literature was performed by a medical reference librarian on 10 August 2018 and two independent reviewers identified relevant publications,extracted data,and assessed the methodological quality based on a validated tool.A retrospective review of the Mayo Clinic electronic medical records identified one case of pouch volvulus between January 2008 and August 2018.Results:The frequency of pouch volvulus from one large published study reporting long-termoutcomes of IPAA was 0.18%(3/1,700).A total of 22 patients(18 ulcerative colitis)were included(median age 32 years,73%females).Median time to volvulus after IPAA was 36 months while median interval to volvulus diagnosis from symptom onset was 24 hours.Abdominal pain was the most commonly reported symptom(76%).The diagnosis was made primarily by abdominal computed tomography(13/17 patients,76%).Endoscopic treatment was successful in 1 of 11 patients(9%).Surgery was performed in 20 patients and pouch-pexy and pouch excision were the most frequent surgical operations.A redo IPAA was performed in five patients(25%).Conclusion:Pouch volvulus is a rare but serious complication of IPAA and should be suspected even in the absence of obstruction symptoms.Endoscopic treatment often fails and surgery is effective when performed early.展开更多
文摘Ischemic colitis can mimic a carcinoma on computed tomographic (CT) imaging or endoscopic examination. A coexisting colonic carcinoma or another potentially obstructing lesion has also been described in 20% of the cases of ischemic colitis. CT scan can differentiate it from colon cancer in 75% of cases. However, colonoscopy is the preferred method for diagnosing ischemic colitis as it allows for direct visualization with tissue sampling. Varied presentations of ischemic colitis have been described as an ulcerated or submucosal mass or as a narrowed segment of colon with ulcerated mucosa on colonoscopy. Awareness and early recognition of such varied presentations of a common condition is necessary to differentiate from a colonic carcinoma, and to avoid unnecessary surgery and related complications.
文摘Ischemic colitis accounts for 6%-18% of the causes of acute lower gastrointestinal bleeding.It is often multifactorial and more commonly encountered in the elderly.Several medications have been implicated in the development of colonic ischemia.We report a case of a 54-year old woman who presented with a two-hour history of nausea,vomiting,abdominal pain,and bloody stool.The patient had recently used lubiprostone with close temporal relationship between the increase in the dose and her symptoms of rectal bleeding.The radiologic,colonoscopic and histopathologic findings were all consistent with ischemic colitis.Her condition improved without any serious complications after the cessation of lubiprostone.This is the first reported case of ischemic colitis with a clear relationship with lubiprostone(Naranjo score of 10).Clinical vigilance for ischemic colitis is recommended for patients receiving lubiprostone who are presenting with abdominal pain and rectal bleeding.
文摘Casals et al have reported an inverse correlation between serum phosphate and body weight after administration of sodium phosphate at a dose of 60 g. Our group has already described the relationship between body weight and hyperphosphatemia with these preparations, although our study was not quoted by Casals. We performed a pharmacokinetic study involving 13 volunteers who were divided into two groups on the basis of body weight： group I consisting of seven women with a median weight of 60 kg and group Ⅱ consisting of five men and one woman with a median weight of 119.2 kg. Group Ⅰdeveloped higher peak phosphate levels and maintained these levels above the subjects in Group Ⅱ for a prolonged time period despite adequate hydration being ensured with frequent monitoring of weight, fluid intake and total body weight. Our studydemonstrated that adequate hydration does not protect against the secondary effects of hyperphosphatemia. In the study by Casais et al, 66% of the study subjects were women, the correlation between serum phosphate and gender in their data also appears to be important. Women are at higher risk of acute phosphate nephropathy due to a diminished volume of distribution of the high dose of ingested phosphate. Decreased volume of distribution in women is due to diminished body weight. This is further compounded by decreased creatinine clearance in females.
文摘Radiographical modalities have become important diagnostic tools in cases of ulcerative colitis(UC).Imaging can be used non-invasively to determine the extent of involvement,severity of disease and to detect disease-related complications and extra-intestinal inflammatory bowel disease(IBD)manifestations.While abdominal X-rays and barium enemas still retain their relevance in specific clinical settings,the use of computed tomography enterography(CTE)or magnetic resonance enterography(MRE)are now used as first-line investigations to exclude active small bowel disease in IBD patients and can be utilized to detect active colonic inflammation.Additionally,CT colonography and MR colonography are emerging techniques with potential applications in UC.Ultrasonography,leukocyte scintigraphy and positron emission tomography are novel abdominal imaging modalities currently being explored for IBD interrogations.This plethora of radiological imaging options has become a vital component of UC assessments.
基金No source of funding has been declared by the authors.The guidelines of the PRISMA 2009 statement were adopted.
文摘Background:Proctocolectomy with ileal pouch–anal anastomosis(IPAA)is the surgical procedure of choice for medically refractory ulcerative colitis and familial adenomatous polyposis.While rare,a pouch volvulus can occur.We aimed to determine the frequency,presentation,and management approach of pouch volvulus in patients with IPAA.Methods:A systematic search of published literature was performed by a medical reference librarian on 10 August 2018 and two independent reviewers identified relevant publications,extracted data,and assessed the methodological quality based on a validated tool.A retrospective review of the Mayo Clinic electronic medical records identified one case of pouch volvulus between January 2008 and August 2018.Results:The frequency of pouch volvulus from one large published study reporting long-termoutcomes of IPAA was 0.18%(3/1,700).A total of 22 patients(18 ulcerative colitis)were included(median age 32 years,73%females).Median time to volvulus after IPAA was 36 months while median interval to volvulus diagnosis from symptom onset was 24 hours.Abdominal pain was the most commonly reported symptom(76%).The diagnosis was made primarily by abdominal computed tomography(13/17 patients,76%).Endoscopic treatment was successful in 1 of 11 patients(9%).Surgery was performed in 20 patients and pouch-pexy and pouch excision were the most frequent surgical operations.A redo IPAA was performed in five patients(25%).Conclusion:Pouch volvulus is a rare but serious complication of IPAA and should be suspected even in the absence of obstruction symptoms.Endoscopic treatment often fails and surgery is effective when performed early.
