Ann Coloproctol.  2018 Aug;34(4):175-179. 10.3393/ac.2017.06.14.1.

Obstructive Ileocolitis in Patients With Obstructed Colorectal Cancer – A Matched Case Control Study

Affiliations
  • 1Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore. ker_kan_tan@nuhs.edu.sg

Abstract

PURPOSE
Obstructive ileocolitis is an ulcero-inflammatory condition which typically occurs in the ileum or colon proximal to an obstructing colorectal lesion. If left unresolved, it often leads to intestinal perforation. We present a matched case control study of patients with obstructive ileocolitis caused by colorectal cancer to determine if any factors can predict this condition.
METHODS
This is a retrospective review of 21 patients with obstructive colorectal cancer and histologically proven obstructive ileocolitis from 2005 to 2015 matched for age and sex with 21 controls with obstructing colorectal cancer without obstructive ileocolitis.
RESULTS
The 21 patients with obstructive ileocolitis had a median age of 71 years (range, 52-86 years). The most common presenting symptom was abdominal pain (n = 16, 76.2%), followed by vomiting/nausea (n = 14, 66.7%) and abdominal distension (n = 12, 57.1%). Interestingly, the radiological feature of pneumatosis intestinalis was noted in only 1 case. No significant differences were observed in baseline comorbidities, clinical presentations, or tumor characteristics between the 2 groups. Patients with obstructive ileocolitis were found to have a significantly higher total leucocyte count (17.1 ± 9.4×109/L vs. 12.0 ± 6.8×109/L, P = 0.016), lower pCO2 (32.3 ± 8.2 mmHg vs. 34.8 ± 4.9 mmHg, P = 0.013), lower HCO3 (18.8 ± 4.5 mmol/L vs. 23.6 ± 2.7 mmol/L, P < 0.001), lower base excess (-6.53 ± 5.32 mmol/L vs. -0.57 ± 2.99 mmol/L, P < 0.001) and higher serum lactate levels (3.14 ± 2.19 mmol/L vs. 1.19 ± 0.91 mmol/L, P = 0.007) compared to controls. No radiological features were predictive of obstructive ileocolitis.
CONCLUSION
Patients with obstructive ileocolitis tend to present with metabolic acidosis with respiratory compensation, raised lactate, and worse leucocytosis. Radiological features are not useful for predicting this condition.

Keyword

Colorectal cancer; Intestinal obstruction; Obstructive ileocolitis

MeSH Terms

Abdominal Pain
Acidosis
Case-Control Studies*
Colon
Colorectal Neoplasms*
Comorbidity
Compensation and Redress
Crohn Disease*
Humans
Ileum
Intestinal Obstruction
Intestinal Perforation
Lactic Acid
Retrospective Studies
Lactic Acid
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