Patterns of Involvement in 350 Cases of Biopsy-Proven Ischemic Colitis

Purpose: The aim of this study was to examine the frequency with which specific anatomic regions of the colon are affected by ischemic injury. Methods: Patients were identified using computerized searches of ICD-9 codes for colon ischemia. All appropriate colonoscopy and pathology reports from January 1, 1998 to December 31, 2007 were reviewed. Patients were included only if colonoscopy reports were consistent with and pathology reports supported the diagnosis of ischemic colitis. Patterns of colon involvement were then tabulated and categorized. Results: Colon involvement in ischemic colitis was classified into 5 major regional patterns: right colon, transverse colon, left colon, distal colon and pan-colon involvement. Patterns were based on the most proximal location of injury and extended to the most distally affected region of the colon. 350 study subjects were identified and their patterns of biopsy-proven ischemic colitis tabulated (Table 1 and Table 2).Table 2: Left, Distal, and Pan-Colon Pattern InvolvementTable 1: Right and Transverse Colon Pattern InvolvementConclusion: 350 cases of biopsy-proven ischemic colitis were identified. No region of colon was spared from ischemic injury, but some were affected more than others. Segmental involvement was typical. The sigmoid was the most frequently involved segment (22.9%), and right colon involvement was seen more frequently (21.1%) than has been previously reported. Pan-colon involvement was seen in 6.6% of cases, most of which were associated with sepsis.