Diversion colitis

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Diversion colitis
Diversion proctitis - intermed mag.jpg
Micrograph showing colonic-type mucosa with follicular lymphoid hyperplasia, as is seen in diversion colitis. H&E stain.
Specialty Gastroenterology
CausesSurgery with diversion of colon (ileostomy or colostomy)
TreatmentShort-chain fatty acid enemas
Medication Mesalazine

Diversion colitis is an inflammation of the colon which can occur as a complication of ileostomy or colostomy, where symptoms may occur between one month and three years following surgery. [1] It also occurs frequently in a neovagina created by colovaginoplasty, with varying delay after the original procedure. [2] Despite the presence of a variable degree of inflammation the most suggestive histological feature remains the prominent lymphoid aggregates.

Contents

Symptoms and signs

People may be asymptomatic but common symptoms are abdominal discomfort, anorectal pain, mucous discharge and rectal bleeding that develops from the inflamed mucosa of the distal, unused colon. [1]

Diagnosis

Diagnosis is aided by knowing the full clinical history. [3]

Treatment

In many milder cases after ileostomy or colostomy, diversion colitis is left untreated and disappears naturally. Possible pharmacologic treatments include short-chain fatty acid irrigation, steroid enemas and mesalazine. [4] For surgical candidates, reanastomosis is a reversal procedure carried out to restore bowel continuity that effectively halts the symptoms of diversion colitis. [1]

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Lymphocytic esophagitis Medical condition

Lymphocytic esophagitis is a rare and poorly understood medical disorder involving inflammation in the esophagus. The disease is named from the primary inflammatory process, wherein lymphocytes are seen within the esophageal mucosa. Symptoms of the condition include difficulty swallowing, heartburn and food bolus obstruction. The condition was first described in 2006 by Rubio and colleagues. Initial reports questioned whether this was a true medical disorder, or whether the inflammation was secondary to another condition, such as gastroesophageal reflux disease.

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Segmental colitis associated with diverticulosis Medical condition

Segmental colitis associated with diverticulosis (SCAD) is a condition characterized by localized inflammation in the colon, which spares the rectum and is associated with multiple sac-like protrusions or pouches in the wall of the colon (diverticulosis). Unlike diverticulitis, SCAD involves inflammation of the colon between diverticula, while sparing the diverticular orifices. SCAD may lead to abdominal pain, especially in the left lower quadrant, intermittent rectal bleeding and chronic diarrhea.

References

  1. 1 2 3 Tominaga K, Kamimura K, Takahashi K, Yokoyama J, Yamagiwa S, Terai S (April 2018). "Diversion colitis and pouchitis: A mini-review". World Journal of Gastroenterology. 24 (16): 1734–1747. doi:10.3748/wjg.v24.i16.1734. PMC   5922993 . PMID   29713128.
  2. van der Sluis WB, Bouman MB, Meijerink WJ, Elfering L, Mullender MG, de Boer NH, van Bodegraven AA (March 2016). "Diversion neovaginitis after sigmoid vaginoplasty: endoscopic and clinical characteristics". Fertility and Sterility. 105 (3): 834–839.e1. doi: 10.1016/j.fertnstert.2015.11.013 . PMID   26632208.
  3. Haboubi, Haboubi (April 2000). "Reporting colonic mucosal biopsies in inflammatory conditions: a new approach". Colorectal Disease. 2 (2): 66–72. doi:10.1046/j.1463-1318.2000.00104.x. PMID   23577987. S2CID   40271111.
  4. Geraghty JM, Talbot IC (September 1991). "Diversion colitis: histological features in the colon and rectum after defunctioning colostomy". Gut. 32 (9): 1020–3. doi:10.1136/gut.32.9.1020. PMC   1379042 . PMID   1916483.