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:[1][2]
- 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:
Ischemic colitis | |||||||||||||||||||||||||||||||||
Acute ischemic colitis | Chronic ischemic colitis | ||||||||||||||||||||||||||||||||
Occlusive | Non-occlusive | ||||||||||||||||||||||||||||||||