Inflammatory Bowel Disease-Pathology

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Slide 58.   Diversion Colitis

It is likely that the integrity of the colonic mucosa is in part dependant on constant exposure to lumenal contents.  Certain substances are thought to act as epithelial trophic factors, including short chain fatty acids.  In patients who have had defunctionalization of a segment of large intestine (for example, distal colorectum in patients with longstanding colostomy), these stimuli are lost.  Whatever the cause, the disuse of a diverted segment of colon is associated with the striking histologic changes shown in this image.  Lymphoid hyperplasia is the most conspicuous inflammatory change, although both active crypt injury and focal granulomatous inflammation may be seen.  Mucosal atrophy, hypertrophy of the muscularis mucosae and mucosal and submucosal fibrosis may also be apparent.  Endoscopic examination reveals an erythematous, granular mucosa that may resemble active ulcerative colitis.  Considering the striking histologic similarity with ulcerative colitis as well, the surgical anatomy of the colon should be reviewed before diagnosis is rendered, lest a biopsy from a diverted segment be confused for a process representative of actively inflamed mucosa still exposed to the fecal stream.

Harig JM, Soergel KH, Komorowski RA, et al.: Treatment of diversion colitis with short-chain fatty acid irrigation.  New Engl J Med 1989; 320:23-28.

Haque S, Eisen RN, West AB: The morphologic features of diversion colitis: studies of a pediatric population with no other disease of the intestinal mucosa.  Hum Pathol 1993; 24:211-219.

Ma CK, Gottlieb C, Hass DA: Diversion colitis: a clinicopathologic study of 21 cases.  Hum Pathol 1990; 21:429-436.