Colon
Noninfectious colitis
Diversion colitis
Author: Hanni Gulwani, M.B.B.S.
Last author update: 1 May 2013
Last staff update: 27 February 2023
Copyright: 2003-2023, PathologyOutlines.com, Inc.
PubMed Search: diversion colitis
Table of Contents
Definition / general | Etiology | Clinical features | Diagnosis | Case reports | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Differential diagnosisCite this page: Gulwani H. Diversion colitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/colondiversion.html. Accessed April 1st, 2023.
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
- 20 year old woman with fulminant diversion pancolitis presenting 19 years after colonic diversion for neuronal intestinal dysplasia (BMJ Case Rep 2009;2009)
- 51 year old woman with Crohn's disease and microcarcinoids associated with diversion colitis (J Crohns Colitis 2008;2:246)
- With osseous metaplasia (Int J Surg Pathol 2009;17:81)
Treatment
- Enemas, dietary short term fatty acids, restoring continuity of segment (Curr Treat Options Gastroenterol 2001;4:255)
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
Images hosted on other servers:
Diversion proctitis
with diffuse chronic
inflammation but no
architectural distortion
Differential diagnosis
