Difference between revisions of "Diversion colitis"

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| Width      =
| Width      =
| Caption    = Diversion proctitis. [[H&E stain]].
| Caption    = Diversion proctitis. [[H&E stain]].
| Micro      = follicular lymphoid hyperplasia (abundant lymphoid nodules, plasma cells), +/-changes of an active colitis (cryptitis, crypt abscesses) - uncommon  
| Micro      = follicular lymphoid hyperplasia (abundant lymphoid nodules, plasma cells), +/-changes of an active colitis ([[cryptitis]], crypt abscesses) - uncommon  
| Subtypes  =
| Subtypes  =
| LMDDx      = [[inflammatory bowel disease]] - no stoma, [[ischemic colitis]], [[infectious colitis]]
| LMDDx      = [[inflammatory bowel disease]] - no stoma, [[ischemic colitis]], [[infectious colitis]], [[lymphoma]]
| Stains    =
| Stains    =
| IHC        =
| IHC        =
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| Prognosis  = usu. resolves with re-anastomosis
| Prognosis  = usu. resolves with re-anastomosis
| Other      =
| Other      =
| ClinDDx    = other cause of [[colitis]]
| ClinDDx    = other causes of [[colitis]]
}}
}}
'''Diversion colitis''' is [[colitis]] due to a diversion, i.e. a [[stoma]]. '''Diversion proctitis''' redirects here.
'''Diversion colitis''' is [[colitis]] due to a diversion, i.e. a [[stoma]]. '''Diversion proctitis''' redirects here.
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*[[Plasma cell]]s and lymphocytes.
*[[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>
*+/-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.
**[[Cryptitis]].
**Crypt abscesses.
**[[Crypt abscesses]].


Notes:
Notes:

Latest revision as of 04:04, 23 December 2013

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]

Images

  • Diversion proctitis - low mag. (WC/Nephron)

  • Diversion proctitis - high mag. (WC/Nephron)

Sign out

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/.
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