Volume 29, Issue 4, 2020
DOI: 10.24205/03276716.2020.872
Chemotherapy-Induced Ischemic Colitis: Literature Review and Pooled Analysis
Abstract
Background: The clinical characteristics of chemotherapy-induced ischemic colitis (CIC), as a special type of chemotherapeutic colitis, have important significance for its diagnosis and treatment. In this article, available literatures relating to CIC were assessed to summary its pathogeneses, prognoses and treatment.
Methods: A broad review of the English based literatures on patients with CIC was performed the online PubMed database. Data were collected, including sex, age, clinical presentations, imaging findings, pathological features, and follow-up Discrete variables were expressed as frequencies and percentages, and continuous variables as means ± standard deviations. The Logistic Regression method was used to assess the effect of clinically relevant varieties on prognosis.
Results: To date, 13 related literatures about 16 clinical cases of CIC were reported. By review of these literatures, the clinical characteristics of CIC were summarized. The cohort comprised of 10 male and 6 female patients. The age at presentation was 59.94 ± 15.95 years (range, 20–82 years). The mean of the chemotherapy cycles cases with CIC received was 3.20 ± 4.06. The main clinical symptoms are gastrointestinal and systemic symptoms. The gastrointestinal symptom included abdominal pain (15, 93.8%), diarrhea (11, 68.8%), hematochezia (10, 62.5%) and constipation (1, 6.3%), but no nausea or vomiting. Stool cultures of all cases reported were negative. The abdominal computed tomography (CT) and X-ray revealed the thickened colon wall and the thrombosis in mesenteric vessels. And pathological biopsy was the gold standard for diagnosis of CIC. Histological examination revealed extensive ischaemic damage with or without thrombosis from colonoscopy and hemicolectomy. Moreover, ten patients (62.5%) received medical treatment including total parental nutrition, mesalazin, antibiotic and oral rehydration solutions, which were all recovery. Five patients (31.3%) with acute abdomen received emergency surgery including hemicolectomy/ total colectomy with partial proctectomy/ ileostomy, and only one of them was recovery.
Conclusion: The main clinical symptoms of CIC are gastrointestinal and systemic symptoms. However, laboratory stool tests and bloodwork are usually normal. The main pathological mechanisms of CIC are thrombosis, angiogenesis inhibition, and vasoconstriction. The most common treatments are immediate chemotherapy cessation, medical treatments and surgery.
Keywords
chemotherapy, ischemia, colitis, diagnosis, pathogenesis, treatment