Colon non tumor
Infectious colitis (specific microorganisms)
Acute self limited colitis

Author: Lili Lee, M.D. (see Authors page)

Revised: 9 January 2017, last major update January 2014

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: Acute self limited[title]colitis
Cite this page: Acute self limited colitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/colonacuteselflimited.html. Accessed January 24th, 2017.
Definition / General
  • Due to infections, NSAID or other drugs, bowel preparation or procedure associated injury (eg. gluteraldehyde disinfection of endoscope, Endoscopy 1998;30:428)
  • Not always acute or self-limited
Etiology
  • Causes:
    • Ingestion of pre-formed toxins (Staphylococcus aureus, Vibrio cholera, Clostridium perfringens; cause symptoms within hours including explosive diarrhea)
    • Infection by toxigenic organisms (incubation of hours to days)
    • Infection by enteroinvasive organisms which invade and destroy mucosal epithelium cells
    • Infection by viral organisms (CMV, HSV, HIV, etc.)
  • Bacterial virulence factors include:
    • Adherence to epithelial cells
    • Enterotoxins
    • Invasion factors
    • Cytotoxicity
  • Adherence:
    • Via fimbriae or pili
    • The process of adherence destroys the microvilli brush border
  • Enterotoxins:
    • Toxin binds to cell membrane, enters cell, activates massive electrolyte secretion (cholera toxin, E. coli heat-labile and heat-stable toxins produce travelers diarrhea)
    • No white blood cells in stool
  • Invasion factors:
    • Enteroinvasive E. coli and Shigella invade via microbe-simulated endocytosis
    • Then intracellular proliferation, cell lysis, cell to cell spread
  • Cytotoxicity:
    • Shiga toxin, enterohemorrhagic E. coli
Clinical Features
  • Abdominal pain, watery or bloody diarrhea
  • Sudden onset, early fever, often with numerous (greater than 6) bowel movements daily
  • Complications of dehydration, sepsis, perforation can occur secondary to potential massive fluid loss and loss of mucosal barrier
Diagnosis
  • Stool cultures
  • Colonoscopy with mucosal biopsy
Laboratory
  • High white blood cell count (leukemoid reaction) with left shift
Radiology Description
  • Limited role since inflammatory abnormalities are nonspecific (eg. colonic wall thickening)
Case Reports
Treatment
  • Supportive therapy with rehydration
  • Rarely may require antibiotics or steroids
Clinical Images

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Gross description

Gross Description
  • Ulceration, erosion, pseudomembranes, pseudopolyps, hyperemia
Micro Description
  • Inflammation of lamina propria (active much greater than chronic), edema, hemorrhage
  • Usually lacks features of chronicity (crypt architectural distortion, lymphoplasmacytosis, pyloric gland metaplasia, Paneth cell metaplasia in the left colon)
  • Neutrophil induced epithelial injury (cryptitis)
  • Severe cases have crypt abscesses, extensive necrosis, hemorrhage and microthrombi
Micro Images

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Decreased number of goblet cells

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Numerous crypt abscess, cryptitis

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Purulent cryptitis and dense inflammation


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Mucosal bleeding and non-specific inflammation

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Neutrophils in surface epithelium

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Mild superficial increase in chronic inflammation

Differential Diagnosis
Additional References