Epidemiology, Clinical Features, High-Risk Factors, and Outcome of Acute Large Bowel Ischemia

Background & Aims Only a limited amount of important information is available on acute lower bowel ischemia (ALBI). We investigated the epidemiology, clinical aspects, high-risk factors, and outcome of ALBI. Methods We retrospectively analyzed data collected from 401 patients with 424 hospitalizations with ALBI in a prepaid health system for 7 years. Results The estimated annual incidence of ALBI was 15.6/100,000 patient-years (22.6 female, 8.0 male), with a marked age-related increase. ALBI preceded 400 admissions (94%) and followed surgery or medical admission of 24 patients (6%); 307 (72%) had rectal bleeding and abdominal pain. In 417 episodes, left-sided or transverse (368, 88%) exceeded right-sided or bilateral ALBI (49, 12%). Thirty-one patients (8%) had resection; 15 died (4%). Factors that were independently associated with resection and/or death included right-sided or bilateral distribution (adjusted odds ratio [AOR], 14.64; 95% confidence interval [CI], 4.82–44.50; P < .001), onset after admission (AOR, 7.48; 95% CI, 2.19–25.54; P < .005), hypotension (AOR, 4.45; 95% CI, 1.18–16.76; P < .05), tachycardia (AOR, 4.40; 95% CI, 1.46–13.26; P < .01), warfarin use (AOR, 4.33; 95% CI, 1.21–15.47; P < .05), antibiotic therapy (AOR, 3.94; 95% CI, 1.23–12.64; P < .05), male sex (AOR, 2.65; 95% CI, 1.00–7.05; P = .05), nonsteroidal anti-inflammatory drug use (AOR, 0.15; 95% CI, 0.04–0.53; P < .005), and rectal bleeding (AOR, 0.24; 95% CI, 0.09–0.65; P < .005). During a mean of 2.6 ± 1.9 years, no patient developed chronic colitis, and 1 (