Ischemic colitis classification: Difference between revisions
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==== Transient: the most common form ==== | ==== Transient: the most common form ==== | ||
* Present with [[abdominal pain]], [[rectal bleeding]] and full-thickness involvement of the [[Mucous membrane|mucosa]] | * Present with [[abdominal pain]], [[rectal bleeding]] and full-thickness involvement of the [[Mucous membrane|mucosa]] | ||
==== Chronic segmental or chronic ulcerative ==== | ==== Chronic segmental or chronic ulcerative ==== | ||
* Persistent symptoms or recurrent episodes of [[pain]], [[rectal bleeding]], [[diarrhea]], and segmental colitis on [[imaging]] | * Persistent symptoms or recurrent episodes of [[pain]], [[rectal bleeding]], [[diarrhea]], and segmental colitis on [[imaging]] | ||
* [[Resection]] is usually curative | * [[Resection]] is usually curative | ||
==== [[Ischemia|Ischemic]] colonic [[Stenosis|stricture]] ==== | ==== [[Ischemia|Ischemic]] colonic [[Stenosis|stricture]] ==== | ||
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==== [[Gangrene|Gangrenous]] colitis ==== | ==== [[Gangrene|Gangrenous]] colitis ==== | ||
* Suspected when there is increasing [[abdominal pain]], [[Medical sign|signs]] of local or generalized [[peritonitis]], [[Fever|fevers]] or [[ileus]] | * Suspected when there is increasing [[abdominal pain]], [[Medical sign|signs]] of local or generalized [[peritonitis]], [[Fever|fevers]] or [[ileus]] | ||
==== Universal [[fulminant]] [[pancolitis]] ==== | ==== Universal [[fulminant]] [[pancolitis]] ==== | ||
* Presents acutely with severe symptoms, progressive transmural [[infarction]] and [[necrosis]] of the entire [[Colon (anatomy)|colon]], resultant [[sepsis]] and [[perforation]] | * Presents acutely with severe symptoms, progressive transmural [[infarction]] and [[necrosis]] of the entire [[Colon (anatomy)|colon]], resultant [[sepsis]] and [[perforation]] | ||
* 75% [[mortality rate]] | * 75% [[mortality rate]] | ||
* [[Symptom|Symptoms]] include [[sepsis]], severe [[abdominal pain]], [[peritonitis]] and [[rectal bleeding]] | * [[Symptom|Symptoms]] include [[sepsis]], severe [[abdominal pain]], [[peritonitis]] and [[rectal bleeding]] | ||
=== Percentage for each type: === | === Percentage for each type: === | ||
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==== [[Acute]] ischemic colitis ==== | ==== [[Acute]] ischemic colitis ==== | ||
*[[Thromboembolism|Occlusive]] | *[[Thromboembolism|Occlusive]] | ||
**Due to [[Artery|arterial]] or [[Vein|venous]] [[thrombosis]] blocking [[blood]] supply | **Due to [[Artery|arterial]] or [[Vein|venous]] [[thrombosis]] blocking [[blood]] supply | ||
*Non-Occlusive | *Non-Occlusive | ||
**Due to [[Shock|hypoperfusion]] of the [[Colon (anatomy)|colon]] | **Due to [[Shock|hypoperfusion]] of the [[Colon (anatomy)|colon]] | ||
==== [[Chronic]] ischemic colitis. ==== | ==== [[Chronic]] ischemic colitis. ==== | ||
Revision as of 20:08, 31 January 2018
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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: reversible 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 below types based on disease clinical features:[1][2][3][4]
Reversible ischemic colopathy
- Characterized by submucosal hemorrhage at endoscopy, with involvement of superficial mucosa.
- Self-limiting
Transient: the 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, fevers or ileus
Universal fulminant pancolitis
- Presents acutely with severe symptoms, progressive transmural infarction and necrosis of the entire colon, resultant 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 |
Also, ischemic colitis can be classified based on its clinical course into two types:
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.