Ischemic colitis classification: Difference between revisions

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** This presents acutely with severe symptoms, progressive transmural infarction and necrosis of the entire colon, resultant sepsis and perforation with a 75% mortality rate.
** 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.
** These patients present with sepsis, severe abdominal pain, peritonitis and per-rectal bleeding.
<br>
{|
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Classification of ischemic colitis by percentage
|-
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Cancers
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Percentage (%)
|-
| style="background:#DCDCDC;" align="center" + |Colon
| style="background:#F5F5F5;" align="center" + |39
|-
| style="background:#DCDCDC;" align="center" + |Stomach
| style="background:#F5F5F5;" align="center" + |29
|-
| style="background:#DCDCDC;" align="center" + |Small Bowel
| style="background:#F5F5F5;" align="center" + |13
|-
| style="background:#DCDCDC;" align="center" + |Pancraes
| style="background:#F5F5F5;" align="center" + |11 to 39
|}
Ischemic colitis can be classified based on its clinical course into two types:  
Ischemic colitis can be classified based on its clinical course into two types:  
*[[Acute]] ischemic colitis
*[[Acute]] ischemic colitis

Revision as of 14:12, 8 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][5]

  • 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.


Classification of ischemic colitis by percentage
Cancers Percentage (%)
Colon 39
Stomach 29
Small Bowel 13
Pancraes 11 to 39

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

  1. Hunter GC, Guernsey JM (1988). "Mesenteric ischemia". Med. Clin. North Am. 72 (5): 1091–115. PMID 3045452.
  2. 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.
  3. 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.
  4. . doi:10.3109/10.3748/wjg.14.7302. Missing or empty |title= (help)
  5. 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.