Related Experiment Videos
Diversion colitis in children: an iatrogenic appendix vermiformis?
1Department of Pathology, University of Wales College of Medicine, Cardiff, UK. vujanic@cf.ac.uk
Insights
Diversion colitis (DC) in children shares histological features with adults, aiding differential diagnosis. Key findings include lymphoid hyperplasia and inflammation, distinguishing it from other pediatric colitides.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Surgical Pathology
Background:
- Diversion colitis (DC) is a common iatrogenic condition in diverted colonic segments after ileostomy or colostomy.
- Understanding its histological features in children is crucial for accurate diagnosis and management.
Purpose of the Study:
- To establish and describe the characteristic histological features of diversion colitis in pediatric patients.
- To differentiate DC from other colonic pathologies in children, such as ulcerative colitis and Hirschsprung's-associated enterocolitis.
Main Methods:
- Analysis of 23 pediatric cases of diversion colitis following colostomy for Hirschsprung's disease.
- Detailed examination of histological findings, including mucosal inflammation, lymphoid hyperplasia, and metaplasia.
Main Results:
- Consistent findings in pediatric DC include prominent follicular lymphoid hyperplasia (100%) and chronic mucosal inflammation (100%).
- Variable acute inflammation (78%), Paneth cell metaplasia (26%), and eosinophil aggregates (43%) were also observed.
- Histological features showed significant similarity to those in adults and the normal appendix.
Conclusions:
- Pediatric diversion colitis exhibits histological characteristics similar to adult DC, aiding in distinguishing it from ulcerative colitis and Hirschsprung's-associated enterocolitis.
- Recognition of these features is vital to prevent misdiagnosis and inappropriate treatment in children.
- The study highlights similarities between diversion colitis and the normal appendix vermiformis.
Aims:
Diversion colitis (DC) is a localized, relatively benign, iatrogenic condition which occurs in almost 100% of diverted colonic segments in patients who undergo ileostomy/colostomy for various reasons. The aim of this study was to establish histological features of DC in children.
Methods And Results:
Twenty-three cases of DC following colostomy for Hirschsprung's disease in young children were analysed. The distinguishing features included prominent follicular lymphoid hyperplasia (100%), chronic mucosal inflammation (100%), accompanied by a variable degree of acute inflammation (78%) and Paneth cell metaplasia (26%). Less frequent histological findings were as follows: mild goblet cell depletion (22%), foci of cryptitis (13%), crypt abscesses (13%) and mild architectural distortion (22%). A previously unrecognized feature was the presence of mucosal aggregates of eosinophils, found in 43% of cases. A striking similarity between the normal appearance of the vermiform appendix and pathological features in DC was noted and the possible relationship between the two is discussed.
Conclusions:
Histological features of DC in children are very similar to those described in adults. They should help to distinguish it from ulcerative colitis and Hirschsprung's-associated enterocolitis in order to prevent inappropriate therapy and follow-up. There are many similarities between DC and the normal appendix vermiformis.