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 based on symptom progression into hyperactive phase, paralytic phase, shock phase. 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:

• Reversible ischaemic 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 IC: 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 IC or chronic ulcerative IC:
  • 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:

• Acute ischemic colitis
• Chronic ischemic colitis.

Ischemic colitis

Acute ischemic colitis

Chronic ischemic colitis

Occlusive

Non-occlusive