Colon nontumor
Colitis (noninfectious)
Diversion colitis

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 13 July 2018, last major update May 2013

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: diversion colitis
Cite this page: Gulwani, H. Diversion colitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/colondiversion.html. Accessed October 20th, 2018.
Definition / general
  • Also called defunctionalized bowel
  • Due to dietary deprivation of short chain fatty acids normally produced by colonic bacteria, important for caloric supply of colonic enterocytes
  • Similar histologic features regardless of cause for diversion, although patients with inflammatory bowel disease (IBD) may have superimposed IBD histologic changes
  • In children, resembles normal appendix (Histopathology 2000;36:41, Hum Pathol 1993;24:211)
Etiology
  • Ileostomy, colostomy, other surgical diversion
Clinical features
  • Symptoms varies from none to severe diarrhea resembling ulcerative colitis
Diagnosis
  • Can only diagnose with confidence if colon was noninflamed at time of surgical diversion
Case reports
Treatment
Gross description
  • Varies from minimal mucosal friability to ulceration
Microscopic (histologic) description
  • Marked lymphoid hyperplasia resembling follicular proctitis or aphthous lesions, initially in lamina propria but later transmural (Am J Surg Pathol 1990;14:548, Hum Pathol 1990;21:429)
  • Mild colitis with crypt abscesses
  • Late in disease develop muscularis mucosa hypertrophy, fatty and fibrous infiltration of submucosa, thickened muscularis propria and narrow lumen (Colorectal Dis 2007;9:601); no architectural distortion
Microscopic (histologic) images

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Diversion proctitis with diffuse chronic
inflammation of lamina propria and crypt
abscesses but no architectural distortion