Ischemic colitis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]; Mehrian Jafarizade, M.D [3]
Overview
Ischemic colitis may be classified on the degree of the histopathological damage in the colonic wall as reversible ischemic colopathy (submucosal or intramural bleeding), transient colitis, chronic segmental ischemia, gangrenous colitis, and universal fulminant colitis. Also, based on its clinical course into two types: acute ischemic colitis or chronic ischemic colitis.
Classification
Ischemic colitis can be classified into the following types based on clinical features of disease:[1][2][3][4]
Reversible ischemic colopathy
- Characterized by submucosal hemorrhage at endoscopy, with involvement of superficial mucosa
- Self-limiting
Transient (most common form)
- Present with abdominal pain, rectal bleeding and full-thickness involvement of the mucosa
Chronic segmental or chronic ulcerative
- Persistent symptoms or recurrent episodes of pain, rectal bleeding, diarrhea, and segmental colitis on imaging
- Resection is usually curative
Ischemic colonic stricture
- Found at follow-up endoscopy
Gangrenous colitis
- Suspected when there is increasing abdominal pain, signs of local or generalized peritonitis, fever or ileus
Universal fulminant pancolitis
- Presents acutely with severe symptoms, progressive transmural infarction and necrosis of the entire colon
- Results in sepsis and perforation
- 75% mortality rate
- Symptoms include sepsis, severe abdominal pain, peritonitis and rectal bleeding
Percentage for each type:
| Classification of ischemic colitis by percentage | |
|---|---|
| Type | Percentage (%) |
| Reversible ischemic colopathy | 3-26.1 |
| Transient | 45 |
| Chronic segmental or ulcerative | 17.9-25 |
| Ischemic colonic stricture | 10-15 |
| Gangrenous colitis | 9.9-19 |
| Universal fulminant pancolitis | 1-2.5 |
Ischemic colitis can be classified into the following types based on clinical course of disease:
Acute ischemic colitis
- Occlusive
- Due to arterial or venous thrombosis blocking blood supply
- Non-Occlusive
- Due to hypoperfusion of the colon
Chronic ischemic colitis
| Ischemic colitis | |||||||||||||||||||||||||||||||||
| Acute ischemic colitis | Chronic ischemic colitis | ||||||||||||||||||||||||||||||||
| Occlusive | Non-occlusive | ||||||||||||||||||||||||||||||||
References
- ↑ Hunter GC, Guernsey JM (1988). "Mesenteric ischemia". Med. Clin. North Am. 72 (5): 1091–115. PMID 3045452.
- ↑ Nikolic, Amanda L.; Keck, James O. (2017). "Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management". ANZ Journal of Surgery. doi:10.1111/ans.14237. ISSN 1445-1433.
- ↑ Montoro, Miguel A.; Brandt, Lawrence J.; Santolaria, Santos; Gomollon, Fernando; Puértolas, Belén Sánchez; Vera, Jesús; Bujanda, Luis.; Cosme, Angel; Cabriada, José Luis; Durán, Margarita; Mata, Laura; Santamaría, Ana; Ceña, Gloria; Blas, Jose Manuel; Ponce, Julio; Ponce, Marta; Rodrigo, Luis; Ortiz, Jacobo; Muñoz, Carmen; Arozena, Gloria; Ginard, Daniel; López-Serrano, Antonio; Castro, Manuel; Sans, Miquel; Campo, Rafael; Casalots, Alex; Orive, Víctor; Loizate, Alberto; Titó, Lluçia; Portabella, Eva; Otazua, Pedro; Calvo, M.; Botella, Maria Teresa; Thomson, Concepción; Mundi, Jose Luis; Quintero, Enrique; Nicolás, David; Borda, Fernando; Martinez, Benito; Gisbert, Javier P.; Chaparro, María; Bernadó, Alfredo Jimenez; Gómez-Camacho, Federico; Cerezo, Antonio; Nuñez, Enrique Casal (2010). "Clinical patterns and outcomes of ischaemic colitis: Results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study)". Scandinavian Journal of Gastroenterology. 46 (2): 236–246. doi:10.3109/00365521.2010.525794. ISSN 0036-5521.
- ↑ O’Neill, Stephen; Elder, Kenny; Harrison, Sarah J.; Yalamarthi, Satheesh (2011). "Predictors of severity in ischaemic colitis". International Journal of Colorectal Disease. 27 (2): 187–191. doi:10.1007/s00384-011-1301-x. ISSN 0179-1958.