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Diversion colitis clinical and pathologic features

Marleen Spijkerman, Ineke L Tan, Jeroen J Kolkman, Sebo Withoff, Cisca Wijmenga, Marijn C Visschedijk, Rinse K Weersma
BACKGROUND AND AIMS: Celiac disease (CeD) is a gluten triggered, immune-mediated disease of the small intestine. Few clinical cohort descriptions are available, despite the diverse clinical picture. This study provides an overview of a large Dutch CeD cohort focusing on presenting symptoms, co-occurrence of immune mediated diseases (IMD) and malignancies. METHODS: We performed a retrospective study in a Dutch university and a non-university medical hospital and included only biopsy proven (≥Marsh type 2 classification) CeD patients...
May 2016: Digestive and Liver Disease
Gian Eugenio Tontini, Maurizio Vecchi, Luca Pastorelli, Markus F Neurath, Helmut Neumann
Distinction between Crohn's disease of the colon-rectum and ulcerative colitis or inflammatory bowel disease (IBD) type unclassified can be of pivotal importance for a tailored clinical management, as each entity often involves specific therapeutic strategies and prognosis. Nonetheless, no gold standard is available and the uncertainty of diagnosis may frequently lead to misclassification or repeated examinations. Hence, we have performed a literature search to address the problem of differential diagnosis in IBD colitis, revised current and emerging diagnostic tools and refined disease classification strategies...
January 7, 2015: World Journal of Gastroenterology: WJG
Robert D Odze
Distinguishing ulcerative colitis (UC) from Crohn's disease (CD) is normally based on evaluation of a variety of clinical, radiologic, serologic and pathologic findings, the latter in biopsy and/or resection specimens. Unfortunately, some patients with IBD show overlapping pathologic features of UC and CD, which makes definite distinction between these two disorders difficult or even impossible. In most instances of uncertainty, the patient shows clinical and pathologic features of UC, but in addition, the patient's colon resection specimen reveals one or more CD-like features...
January 2015: Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc
Alba Sánchez-Galán, Ane M Andres, Beatriz Fernández-Caamaño, Alejandra Vilanova, Eva Dominguez, Ruben Ortiz, Gerardo Prieto, Manuel Lopez-Santamaria, J A Tovar
Ulcerative ileitis (UI) after restorative proctocolectomy (RPC) and ileoanal pullthrough procedure (IAPP) is a rare condition described as inflammation of the terminal ileum proximal to the anastomosis. It is mostly observed in ulcerative colitis (UC) and is designated as prepouch ileitis; sometimes with pouchitis, but not necessarily all the time. Its incidence in adults is less than 5%, but the information in children is limited. Pathogenesis is unknown, it has been considered as a disease by itself, independently on the underlying disease...
February 2015: European Journal of Pediatric Surgery
Lisa A Cerilli, Joel K Greenson
CONTEXT: A variety of inflammatory disorders may affect the colon, with widely differing clinical outcomes and management. These conditions encompass a spectrum of acute and chronic conditions. OBJECTIVE: Review the pathology of the major colitides and highlight the most diagnostically useful features. DATA SOURCES: Review of recent literature supplemented with personal experience in the field of gastrointestinal pathology. CONCLUSIONS: The etiologies associated with the various types of colitis are diverse and the range of histologic changes is somewhat limited...
August 2012: Archives of Pathology & Laboratory Medicine
Cheal Wung Huh, Young Hoon Youn, Da Hyun Jung, Do Whan Kim, Bo Gun Kho, Jie Hyun Kim, Hyojin Park, Sang In Lee
Cytomegalovirus (CMV) colitis is common among immunocompromised patients, and often diagnosed by pathologic confirmation because it is associated with a diverse spectrum of clinical and endoscopic features. However, Crohn's disease has no definitive diagnostic criteria, but longitudinal ulcers and cobble stone appearance are accepted as typical endoscopic features of Crohn's disease. An 83 year-old male with a history of radiotherapy for hypopharyngeal cancer visited our hospital with a complaint of melena for 1 week...
April 2012: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
M Szczepkowski, A Kobus, K Borycka
The aim of this study was to present current knowledge about a nospecific inflammation of mucosa within segments of colon excluded from normal bowel passage called as a "diversion colitis" (DC) and to try to determine the role of factors which might modify the clinical course of DC. We also unswered the question; how to treat DC: conservatively or surgically? Our own experience with DC concerns 145 patents (which is most numerous and well exactly examined series presented in literature). In the group of patients studied, clinical signs of DC were present in over 70% of patients (early signs were low abdominal pain and tenesmus, while anal oozing appeared later)...
2008: Acta Chirurgica Iugoslavica
R K Yantiss, R D Odze
This review summarizes some of the common diagnostic problems encountered by pathologists when evaluating patients with chronic colitis and in whom inflammatory bowel disease (IBD) is either suspected or within the differential diagnosis. Both ulcerative colitis (UC) and Crohn's disease (CD) show characteristic, but non-specific, pathological features that may overlap and result in a diagnosis of 'indeterminate colitis' (IC). However, other reasons why pathologists may entertain a diagnosis of IC include failure to recognize or accept certain 'hardcore' histological features as indicative of CD, an attempt to classify cases of chronic colitis based on mucosal biopsy material or in the absence of adequate clinical and radiographic information, and the presence of other disease processes that mask, or mimic, IBD...
January 2006: Histopathology
Wey-Ran Lin, Ming-Yao Su, Chen-Ming Hsu, Yu-Pin Ho, Kah-Wai Ngan, Cheng-Tang Chiu, Pang-Chi Chen
BACKGROUND: The clinical presentations and endoscopic features of cytomegalovirus (CMV) infection in the gastrointestinal (GI) tract are diverse, and can mimic other inflammatory gastrointestinal diseases. METHODS: From 1987 to 2003 at Chang-Gung Medical Center, 20 patients with CMV infections of the GI tract who were assessed using endoscopic examinations and diagnosed via pathologic studies were retrospectively reviewed. RESULTS: Most of the patients were adults with immunocompromised conditions (10/20)...
July 2005: Chang Gung Medical Journal
Hugh J Freeman
Collagenous mucosal inflammatory diseases involve the columnar-lined gastric and intestinal mucosa and have become recognized increasingly as a significant cause of symptomatic morbidity, particularly in middle-aged and elderly women, especially with watery diarrhea. Still, mechanisms involved in the pathogenesis of this diarrhea remain poorly understood and require further elucidation. The prognosis and long-term outcome of these disorders has been documented only to a limited extent. Recent clinical and pathologic studies have indicated that collagenous mucosal inflammatory disease is a more extensive pathologic process that concomitantly may involve several sites in the gastric and intestinal mucosa...
July 2005: Gastroenterology
Carl J Brown, Anthony R Maclean, Zane Cohen, Helen M Macrae, Brenda I O'Connor, Robin S McLeod
PURPOSE: This study was designed to determine the outcome of patients with Crohn's disease and indeterminate colitis who have an ileal pouch-anal anastomosis. METHODS: Between 1982 and 2001, 1,270 patients underwent a restorative proctocolectomy at the Mount Sinai Hospital: 1,135 had ulcerative colitis, 36 had Crohn's disease, 21 had indeterminate colitis, and 78 had another diagnosis. Perioperative data were collected prospectively. Functional outcomes were assessed with a 35-question survey mailed to all patients with a functioning pouch of at least six months duration...
August 2005: Diseases of the Colon and Rectum
Joshua M Braveman, David J Schoetz, Peter W Marcello, Patricia L Roberts, John A Coller, John J Murray, Lawrence C Rusin
PURPOSE: Recent studies have suggested that a subset of patients with Crohn's colitis may have a favorable outcome after ileal pouch-anal anastomosis and have advocated elective ileal pouch-anal anastomosis in selected patients with Crohn's disease. We have not offered ileal pouch-anal anastomosis to patients with known Crohn's disease, but because of the overlap in clinical presentation of ulcerative colitis and indeterminate colitis, some patients receiving an ileal pouch-anal anastomosis are subsequently found to have Crohn's disease...
October 2004: Diseases of the Colon and Rectum
R K Yantiss, P B Clement, R H Young
Endometriosis of the intestinal tract may mimic a number of diseases both clinically and pathologically. The authors evaluated 44 cases of intestinal endometriosis in which endometriosis was the primary pathologic diagnosis, and evaluated them for a variety of gross and histologic changes. Cases with preneoplastic or neoplastic changes were excluded specifically because they were the subject of a previous study. The patients ranged in age from 28 to 56 years (mean age, 44 years), and presenting complaints included abdominal pain (n = 15), an abdominal mass (n = 12), obstruction (n = 8), rectal bleeding (n = 2), infertility (n = 3), diarrhea (n = 2), and increasing urinary frequency (n = 1)...
April 2001: American Journal of Surgical Pathology
G J Ardigo, G F Longstreth, L A Weston, F D Walker
PURPOSE: We report two cases of spontaneous anal passage of a large bowel 'cast' caused by acute ischemic injury. METHODS: Clinical, laboratory, endoscopic, and pathologic features were reviewed, and the literature was searched for similar cases. RESULTS: An 85-year-old male who had undergone aortic surgery recovered from rectosigmoid ischemia after undergoing a descending colostomy. A 74-year-old male with severe pancreatitis developed a postischemic sigmoid stricture but did not have operative treatment before death of pneumonia three months after the episode...
June 1998: Diseases of the Colon and Rectum
B F Warren, N A Shepherd, D C Bartolo, J W Bradfield
Faecal stream diversion may induce inflammatory changes in the defunctioned segment of the large intestine. These changes are predominantly mucosal, although confusing histological features including granulomas may be present. The pathology of 15 defunctioned rectal stumps has been studied. All patients had previously undergone urgent total colectomy for ulcerative colitis and rectal stumps had been left in situ while they awaited pelvic ileal reservoir construction. All rectal stumps showed predominantly mucosal disease but there were additional features such as florid lymphoid follicular hyperplasia (12 cases), transmural inflammation (nine cases), granulomas (four cases), fissures (eight cases), and changes akin to ischaemia or to pseudomembraneous colitis (four cases)...
April 1993: Gut
R G Lee
A 29-year-old woman with Behçet's syndrome developed a severe colitis that ultimately required colectomy. The colectomy specimen showed extensive mucosal ulceration with varying longitudinal, fissuring, and aphthoid configurations, usually occurring within a background of normal or focally inflamed mucosa, and associated with a lymphocytic vasculitis involving submucosal veins. A review of the literature reveals 29 additional cases of colitis complicating Behçet's syndrome. The colitis is characterized by multiple ulcers of diverse size, appearance, and depth of penetration involving any portion of the large bowel, occasionally with coexistent ileal or anal disease...
December 1986: American Journal of Surgical Pathology
S Haque, A B West
During the last decade, clinical and pathologic studies of diversion colitis have led to a better understanding of its nature. The clinical features are well described, and the endoscopic appearances, and gross and microscopic pathology are now defined. Thus, firm diagnosis and distinction from other colitides, notably ulcerative colitis and Crohn's disease, are possible in most cases. Restoration of the fecal stream cures diversion colitis, which in some cases may be successfully treated with short-chain fatty acid enemas, although the efficacy of this method remains to be substantiated...
December 1992: Journal of Clinical Gastroenterology
P Averback
Primary cerebral venous thrombosis has a wide clinical and pathological spectrum, which has not been recognized. Seven cases of aseptic cerebral venous thrombosis (5 fatal) are discussed, with pathological study and literature review. Five patients ranged in age from 22 to 31 years. In 3 cases no discernible cause for thrombosis was found. Novel features of these cases include: primary bilateral internal cerebral venous thrombosis; isolated thrombocytopenia; occurrence in the context of (1) ulcerative colitis plus oral contraceptive use, (2) a twin transfusion syndrome, and (3) presenting syndrome five years after mastectomy for carcinoma...
January 1978: Annals of Neurology
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