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Small bowel (small intestine)

Inflammatory disorders

Ulcerative colitis

Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 16 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.


● Severe UC is associated with contiguous backwash ileitis and appendix involvement
● UC also associated with postcolectomy pouchitis
● Rarely diffuse duodenitis is associated with ulcerative colitis, but it does not behave as Crohn’s disease (Am J Surg Pathol 2000;24:1407)
● Diffuse chronic duodenitis in ulcerative colitis patients who have colectomy is a strong predictor of pouchitis (Am J Surg Pathol 2010;34:1672)

Backwash ileitis

● Recommended to restrict use of term to active enteritis involving ileum contiguously from cecum that has a similar or greater degree of active inflammation; mild cases predominantly involves the superficial mucosa in a contiguous pattern
● Focal isolated ileal erosions, mucous gland metaplasia, or patchy edema with mild active inflammation are features of Crohn's disease (Am J Clin Pathol 2006;126:365)

Micro images

Mild backwash ileitis in moderately active cecal chronic ulcerative colitis resection specimen; mucosa of distal ileum is edematous, and villi are slightly wider and flatter than norma; most of the active colitis stops abruptly at transition point between the 2 mucosae; the two most distal villi have the greatest degree of injury, including blunting, edema, and neutrophils in the lamina propria and surface epithelium

Moderate (left) and severe (center, right) backwash ileitis

Terminal ileum inflammation: (A) grade 1, cryptitis; (B) grade 2, scattered crypt abscesses
(C) grade 3, numerous crypt abscesses; (D) grade 4, ulcer

End of Small bowel (small intestine) > Inflammatory disorders > Ulcerative colitis

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