Pathologic Features of Colon Ischemia (CI) and Their Relationship to Symptom Duration: 2017 Presidential Poster Award

Abstract

Introduction: CI is the most common form of intestinal ischemic injury and a common cause of acute lower GI bleeding in elderly pts. Infarction and ghost cells have been described as the pathognomonic features for CI, however, these findings are uncommon. The aim of this study was to determine common pathologic features of CI and their relationship to symptom duration. Methods: A retrospective, multi-centered chart review was performed to determine the association between pathologic features and symptom duration, defined as the time from symptom onset to time of biopsy, among pts with CI. We reviewed the charts of pts diagnosed with CI at Montefiore Medical Center (01/2005 to 07/2015), and Yale-New Haven Hospital (01/2005 to 06/2010). Inclusion criteria: (1) clinical presentation consistent with CI; (2) colonoscopic findings suggestive of CI; and (3) colonic pathology that was either pathognomonic or consistent with CI, as determined by the institutions' pathologists. Pts were excluded if their clinical presentation could be explained by an alternate underlying GI disorder. Pts were grouped based upon the time from symptom onset to pathologic specimen acquisition (e.g. <3 days, 3-5 days or >5-days) and the frequency of pathologic characteristics compared. Results: 616 pts were identified with biopsy-proven CI. The most common pathologic findings included inflammation (51.1%), ulceration (38.2%), fibrosis (26.0%), and necrosis (20.4%) (Table 1). Pathognomonic findings for CI, including ghost cells and infarction, were seen in 0.2% and 1.6% of cases, respectively. 350 of 616 pts had descriptive pathologic findings and a documented date of symptom onset. In these pts, there was a significant relationship between symptom duration and hyalinization of the lamina propria (P=0.05) and cryptitis/crypt abscesses (P=0.01). Hyalinization of the lamina propria was seen most often between 3 and 5 days, and cryptitis/crypt abscess greater than 5 days from symptom onset (Table 2).Table: Table. Characteristics of Study PopulationTable: Table. Relationship between Pathologic Findings and Symptom DurationConclusion: We report that CI is accompanied by a broad spectrum of pathologic findings. Our study suggests that traditional pathognomonic findings of CI, including infarction and ghost cells, are rare, and cannot be relied upon to exclude a diagnosis of CI. Furthermore, only hyalinization of the lamina propria and cryptitis/crypt abscesses were found to have a significant relationship to symptom duration, the former being seen at 3-5 days and the latter more than 5 days after presentation.