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Diversion colitis: a clinicopathologic study of 21 cases
1Department of Pathology, Henry Ford Hospital, Detroit, MI 48202.
Human Pathology
|April 1, 1990
Summary
Diversion colitis, inflammation in defunctionalized bowel after ostomy, presents with varied endoscopic and histopathologic changes. Findings range from mild inflammation to ulceration, rarely mimicking inflammatory bowel disease.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Surgical Pathology
Background:
- Inflammation in defunctionalized bowel segments following ostomy (ileostomy or colostomy) is known but under-documented.
- The term "diversion colitis" was coined in 1981, yet histopathologic changes remain less explored.
Purpose of the Study:
- To investigate the clinical, endoscopic, and histopathologic features of diversion colitis.
- To characterize the spectrum of changes in defunctionalized bowel segments in patients without prior inflammatory bowel disease.
Main Methods:
- Study included 21 patients without a history of inflammatory bowel disease undergoing loop colostomies or Hartmann's procedures.
- Nineteen patients underwent endoscopic examination; tissue from excluded bowel segments was pathologically examined.
Main Results:
- Patients reported symptoms like rectal discomfort, pain, discharge, and bleeding.
- Endoscopic findings included mucous plugs, friability, erythema, ulcers, exudate, and polyps.
- Histopathology revealed nonspecific changes: lymphoplasmacytic infiltrates, mild crypt alterations; severe changes like ulceration were uncommon. Granulomas were noted in two cases.
Conclusions:
- Diversion colitis exhibits a range of endoscopic and histopathologic findings.
- While often mild, severe changes can occur, and granulomas may raise suspicion for Crohn's disease.