Abstracts
1999 Digestive Disease Week

# 2178 ISCHEMIC COLITIS IN YOUNG ADULTS: A SINGLE INSTITUTION EXPERIENCE
Ourania A Preventza, Mayo Clin and Fdn, Rochester, MN; K N Lazaridis, M D Sawyer, Mayo Clin, Rohester, MN

Ischemic colitis (IC) is a well characterized entity in the elderly patient population. However, IC in young adults is not well defined. Thus, the AIM of this study was to investigate the demographics, etiology, clinical features, and prognosis of IC in young adults. METHODS: A retrospective study of young adults (<50 years old) who were consecutively diagnosed with IC over a period of 9 years (1990-1998) was conducted. Diagnosis was based on endoscopic and/or surgical biopsies of the involved colon. Patients with inflammatory, bacterial, microscopic, or lymphocytic colitis were excluded. RESULTS: We identified 38 patients with IC. Mean age at diagnosis was 38±2 years (range: 18-49). Follow-up period was complete at 21±3 months (range: 1 to 77 months). The female to male ratio was 1.9 (25:13). Fifty two percent (13/25) of women were using oral contraceptives (OC). Other potential factors identified were vascular thromboembolism (4/38), vasoactive drugs (4/38), hypovolemia (4/38) and vasculitis (2/38); some patients had more than one predisposing factor. No causative etiology was found in 18 patients (47%). Dominant presenting symptoms were abdominal pain (79%), diarrhea (55%), and rectal bleeding (53%). Signs of ischemic colitis found at colonoscopy were edema, erythema, submucosal hemorrhage, superficial epithelial necrosis, strictures and mucosal gangrene. The most frequent locations of involvement were the rectosigmoid (40%) and descending colon (26%) followed by transverse/splenic flexure (13%), right colon (8%) and pancolitis (13%). Twenty-eight patients were successfully managed with intravenous fluid and bowel rest. Ten patients required surgery for complications of IC, most commonly perforation (5/10). One patient died of IC-related sepsis occurring after cardiopulmonary bypass, and 2 patients died of unrelated disease distant to their episodes of IC. CONCLUSIONS: This is the largest study of young adults with IC to date. We found a strong female predominance and an association with oral contraceptive use, but almost half of the patients did not have an identifiable etiology. Mortality from IC is low in this patient population.

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