Ischemic colitis classification: Difference between revisions
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Ischemic colitis may be classified largely 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. | Ischemic colitis may be classified largely 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. | ||
==History and Symptoms== | ==History and Symptoms== | ||
Ischemic colitis can be classified into:<ref name="pmid3045452">{{cite journal |vauthors=Hunter GC, Guernsey JM |title=Mesenteric ischemia |journal=Med. Clin. North Am. |volume=72 |issue=5 |pages=1091–115 |year=1988 |pmid=3045452 |doi= |url=}}</ref><ref name="NikolicKeck2017">{{cite journal|last1=Nikolic|first1=Amanda L.|last2=Keck|first2=James O.|title=Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management|journal=ANZ Journal of Surgery|year=2017|issn=14451433|doi=10.1111/ans.14237}}</ref> | Ischemic colitis can be classified into:<ref name="pmid3045452">{{cite journal |vauthors=Hunter GC, Guernsey JM |title=Mesenteric ischemia |journal=Med. Clin. North Am. |volume=72 |issue=5 |pages=1091–115 |year=1988 |pmid=3045452 |doi= |url=}}</ref><ref name="NikolicKeck2017">{{cite journal|last1=Nikolic|first1=Amanda L.|last2=Keck|first2=James O.|title=Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management|journal=ANZ Journal of Surgery|year=2017|issn=14451433|doi=10.1111/ans.14237}}</ref><ref name="MontoroBrandt2010">{{cite journal|last1=Montoro|first1=Miguel A.|last2=Brandt|first2=Lawrence J.|last3=Santolaria|first3=Santos|last4=Gomollon|first4=Fernando|last5=Puértolas|first5=Belén Sánchez|last6=Vera|first6=Jesús|last7=Bujanda|first7=Luis.|last8=Cosme|first8=Angel|last9=Cabriada|first9=José Luis|last10=Durán|first10=Margarita|last11=Mata|first11=Laura|last12=Santamaría|first12=Ana|last13=Ceña|first13=Gloria|last14=Blas|first14=Jose Manuel|last15=Ponce|first15=Julio|last16=Ponce|first16=Marta|last17=Rodrigo|first17=Luis|last18=Ortiz|first18=Jacobo|last19=Muñoz|first19=Carmen|last20=Arozena|first20=Gloria|last21=Ginard|first21=Daniel|last22=López-Serrano|first22=Antonio|last23=Castro|first23=Manuel|last24=Sans|first24=Miquel|last25=Campo|first25=Rafael|last26=Casalots|first26=Alex|last27=Orive|first27=Víctor|last28=Loizate|first28=Alberto|last29=Titó|first29=Lluçia|last30=Portabella|first30=Eva|last31=Otazua|first31=Pedro|last32=Calvo|first32=M.|last33=Botella|first33=Maria Teresa|last34=Thomson|first34=Concepción|last35=Mundi|first35=Jose Luis|last36=Quintero|first36=Enrique|last37=Nicolás|first37=David|last38=Borda|first38=Fernando|last39=Martinez|first39=Benito|last40=Gisbert|first40=Javier P.|last41=Chaparro|first41=María|last42=Bernadó|first42=Alfredo Jimenez|last43=Gómez-Camacho|first43=Federico|last44=Cerezo|first44=Antonio|last45=Nuñez|first45=Enrique Casal|title=Clinical patterns and outcomes of ischaemic colitis: Results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study)|journal=Scandinavian Journal of Gastroenterology|volume=46|issue=2|year=2010|pages=236–246|issn=0036-5521|doi=10.3109/00365521.2010.525794}}</ref><ref>{{cite journal|doi=10.3109/10.3748/wjg.14.7302}}</ref> | ||
* Reversible ischemic colopathy | * Reversible ischemic colopathy |
Revision as of 15:42, 4 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 largely 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.
History and Symptoms
Ischemic colitis can be classified into:[1][2][3][4]
- Reversible ischemic colopathy
- 3–26.1% of cases
- This type is characterized by submucosal haemorrhage at endoscopy, with involvement of superficial mucosa.
- It is typically self-limiting.
- Transient: the most common form at
- approximately 45% of cases.
- These patients present with abdominal pain, per-rectal bleeding and full-thickness involvement of the mucosa.
- Chronic segmental or chronic ulcerative
- 17.9–25% of cases.
- These patients present with persistent symptoms or recurrent episodes of pain, per-rectal bleeding, diarrhoea, and segmental colitis on imaging.
- Resection is often curative.
- Ischaemic colonic stricture
- 10–15% of cases.
- This may be detected acutely, however, more frequently is found at follow-up endoscopy.
- Gangrenous colitis
- 9.9–19% of cases.
- This should be suspected when there is increasing abdominal pain, signs of local or generalized peritonitis, fevers or associated ileus.
- Universal fulminant pancolitis
- 1–2.5% of cases.
- This presents acutely with severe symptoms, progressive transmural infarction and necrosis of the entire colon, resultant sepsis and perforation with a 75% mortality rate.
- These patients present with sepsis, severe abdominal pain, peritonitis and per-rectal bleeding.
Ischemic colitis can be classified based on its clinical course into two types:
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.
- ↑ . doi:10.3109/10.3748/wjg.14.7302. Missing or empty
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