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 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
- This type is characterized by submucosal haemorrhage at endoscopy, with involvement of superficial mucosa.
- It is typically self-limiting.
- Transient: the most common form
- These patients present with abdominal pain, per-rectal bleeding and full-thickness involvement of the mucosa.
- Chronic segmental or chronic ulcerative
- 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
- This may be detected acutely, however, more frequently is found at follow-up endoscopy.
- Gangrenous colitis
- This should be suspected when there is increasing abdominal pain, signs of local or generalized peritonitis, fevers or associated ileus.
- Universal fulminant pancolitis
- This presents acutely with severe symptoms, progressive transmural infarction and necrosis of the entire colon, resultant sepsis and perforation.
- 75% mortality rate.
- These patients present with sepsis, severe abdominal pain, peritonitis and per-rectal bleeding.
| Classification of ischemic colitis by percentage | |
|---|---|
| Cancers | 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 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.
- Occlusive
- 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.