Ischaemia: a pathogenetic clue in diversion colitis?

Colorectal Dis. 2007 Sep;9(7):601-5. doi: 10.1111/j.1463-1318.2006.01182.x.

Abstract

Objective: It is not common that, after diversion of the faecal stream by a colostomy, the defunctioned colon develops colitis. The pathogenesis of this colitis is still unclear and it has been proposed that ischaemia may play a major role. Our aim is to look for signs of ischaemia in a group of patients developing colitis after diversion colostomy for various causes.

Method: Surgical specimens from 32 patients resected for colitis developed after diverting colostomy were examined with routine (haematoxylin-eosin) and Elastic-Van Gieson and Perls' stains.

Results: The histological features related to mucosal crypt architecture, crypt epithelium and inflammation were mild, non specific or related to the underlying disease. Fibrosis was present in 21 (65.6%) patients, superficial coagulative necrosis was found in 18 (56%) patients, splitting and/or thickening of muscularis mucosae was present in 20 (62%) patients. The vessels were substantially normal or ectasic without thrombi or alterations in the wall. Evident ischaemia with coagulative necrosis, submucosal oedema and focal fibrosis was detected in only two (6%) patients and an intermediate picture between acute and chronic ischaemia was present in 16 (50%) patients.

Conclusion: It is possible that ischaemia plays some role in the pathogenesis of diversion colitis; however, further studies are needed to firmly establish its role.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child, Preschool
  • Cohort Studies
  • Colitis / diagnosis*
  • Colitis / pathology*
  • Colostomy / methods
  • Female
  • Fibrosis / pathology
  • Humans
  • Infant, Newborn
  • Inflammation
  • Ischemia / diagnosis*
  • Ischemia / pathology*
  • Male
  • Middle Aged
  • Mucous Membrane / pathology
  • Retrospective Studies