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Difference between revisions of "Diversion colitis"
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'''Diversion colitis''' is [[colitis]] due to a diversion, i.e. a [[stoma]]. '''Diversion proctitis''' redirects here. | |||
==General== | |||
*Segment of de-functioned bowel due to surgical diversion, i.e. stoma (ileostomy or [[colostomy]]). | |||
*[[Diagnosis]] dependent on history - '''key point'''. | |||
==Gross== | |||
Features:<ref name=pmid9934577/> | |||
*Ulceration - classic. | |||
*Surgical changes, e.g. fibrotic-appearing thickened wall. | |||
**May not be apparent. | |||
==Microscopic== | |||
Features:<ref name=pmid9934577>{{Cite journal | last1 = Edwards | first1 = CM. | last2 = George | first2 = B. | last3 = Warren | first3 = B. | title = Diversion colitis--new light through old windows. | journal = Histopathology | volume = 34 | issue = 1 | pages = 1-5 | month = Jan | year = 1999 | doi = | PMID = 9934577 }}</ref> | |||
*Follicular lymphoid hyperplasia - '''key feature'''.<ref name=pmid1916687>{{Cite journal | last1 = Yeong | first1 = ML. | last2 = Bethwaite | first2 = PB. | last3 = Prasad | first3 = J. | last4 = Isbister | first4 = WH. | title = Lymphoid follicular hyperplasia--a distinctive feature of diversion colitis. | journal = Histopathology | volume = 19 | issue = 1 | pages = 55-61 | month = Jul | year = 1991 | doi = | PMID = 1916687 }}</ref> | |||
**Abundant lymphoid nodules. | |||
*[[Plasma cell]]s and lymphocytes. | |||
*+/-Changes of an active colitis - uncommon:<ref name=pmid2318485>{{Cite journal | last1 = Ma | first1 = CK. | last2 = Gottlieb | first2 = C. | last3 = Haas | first3 = PA. | title = Diversion colitis: a clinicopathologic study of 21 cases. | journal = Hum Pathol | volume = 21 | issue = 4 | pages = 429-36 | month = Apr | year = 1990 | doi = | PMID = 2318485 }}</ref> | |||
**Cryptitis. | |||
**Crypt abscesses. | |||
Notes: | |||
*May show IBD-like changes.<ref name=pmid16405661>{{Cite journal | last1 = Yantiss | first1 = RK. | last2 = Odze | first2 = RD. | title = Diagnostic difficulties in inflammatory bowel disease pathology. | journal = Histopathology | volume = 48 | issue = 2 | pages = 116-32 | month = Jan | year = 2006 | doi = 10.1111/j.1365-2559.2005.02248.x | PMID = 16405661 }}</ref> | |||
**IBD should '''not''' be diagnosed on a diverted segment of bowel. | |||
DDx:<ref name=pmid20011361>{{Cite journal | last1 = Thorsen | first1 = AJ. | title = Noninfectious colitides: collagenous colitis, lymphocytic colitis, diversion colitis, and chemically induced colitis. | journal = Clin Colon Rectal Surg | volume = 20 | issue = 1 | pages = 47-57 | month = Feb | year = 2007 | doi = 10.1055/s-2007-970200 | PMID = 20011361 | PMC = 2780148| url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780148/ }}</ref> | |||
*[[Inflammatory bowel disease]] - no stoma. | |||
*[[Ischemic colitis]]. | |||
*[[Infectious colitis]]. | |||
**[[Pseudomembranous colitis]]. | |||
===Images=== | |||
<gallery> | |||
Image:Diversion_proctitis_-_low_mag.jpg | Diversion proctitis - low mag. (WC/Nephron) | |||
Image:Diversion_proctitis_-_high_mag.jpg | Diversion proctitis - high mag. (WC/Nephron) | |||
</gallery> | |||
==Sign out== | |||
<pre> | |||
SIGMOID COLON, BIOPSIES: | |||
- MILD ACTIVE COLITIS WITH LAMINA PROPRIA FIBROSIS, SEE COMMENT. | |||
- NEGATIVE FOR DYSPLASIA. | |||
COMMENT: | |||
No granulomas are identified. Follicular lymphoid hyperplasia is not identified; | |||
however, there is no definite submucosa present. | |||
Diverted segments of bowel can have inflammatory bowel disease-like changes. | |||
In the context of a diverted segment of bowel, the findings are compatible with | |||
a diversion colitis. | |||
</pre> | |||
<pre> | |||
RECTUM, BIOPSY: | |||
- CHRONIC ACTIVE PROCTITIS WITH FOCAL ULCERATION, CRYPTITIS AND CRYPT ABSCESSES. | |||
- GRANULATION TISSUE. | |||
- NEGATIVE FOR DYSPLASIA. | |||
COMMENT: | |||
No lymphoid hyperplasia is present. A small lymphoid aggregate is present. | |||
Architectural distortion is present. | |||
In the context of a diverted segment of bowel, the findings are compatible with | |||
a diversion colitis. | |||
</pre> | |||
==See also== | |||
*[[Colon]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Colon]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||