Diversion colitis

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Diversion colitis
Diagnosis in short

Diversion proctitis. H&E stain.

LM follicular lymphoid hyperplasia (abundant lymphoid nodules, plasma cells), +/-changes of an active colitis (cryptitis, crypt abscesses) - uncommon
LM DDx inflammatory bowel disease - no stoma, ischemic colitis, infectious colitis, lymphoma
Site colon, rectum

Clinical history previous diversion - history essential
Prevalence uncommon
Prognosis usu. resolves with re-anastomosis
Clin. DDx other causes of colitis

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:[1]

  • Ulceration - classic.
  • Surgical changes, e.g. fibrotic-appearing thickened wall.
    • May not be apparent.

Microscopic

Features:[1]

Notes:

  • May show IBD-like changes.[4]
    • IBD should not be diagnosed on a diverted segment of bowel.

DDx:[5]

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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.
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.

See also

References

  1. 1.0 1.1 Edwards, CM.; George, B.; Warren, B. (Jan 1999). "Diversion colitis--new light through old windows.". Histopathology 34 (1): 1-5. PMID 9934577.
  2. Yeong, ML.; Bethwaite, PB.; Prasad, J.; Isbister, WH. (Jul 1991). "Lymphoid follicular hyperplasia--a distinctive feature of diversion colitis.". Histopathology 19 (1): 55-61. PMID 1916687.
  3. Ma, CK.; Gottlieb, C.; Haas, PA. (Apr 1990). "Diversion colitis: a clinicopathologic study of 21 cases.". Hum Pathol 21 (4): 429-36. PMID 2318485.
  4. Yantiss, RK.; Odze, RD. (Jan 2006). "Diagnostic difficulties in inflammatory bowel disease pathology.". Histopathology 48 (2): 116-32. doi:10.1111/j.1365-2559.2005.02248.x. PMID 16405661.
  5. Thorsen, AJ. (Feb 2007). "Noninfectious colitides: collagenous colitis, lymphocytic colitis, diversion colitis, and chemically induced colitis.". Clin Colon Rectal Surg 20 (1): 47-57. doi:10.1055/s-2007-970200. PMC 2780148. PMID 20011361. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780148/.