Pathology of the defunctioned rectum in ulcerative colitis.

Abstract

Faecal stream diversion may induce inflammatory changes in the defunctioned segment of the large intestine. These changes are predominantly mucosal,

Histologic Changes in Defunctioned Rectums in Patients With Inflammatory Bowel Disease

“…This feature was not associated with original diagnosis, duration of defunctionalization, or the development of Crohn's disease-like complications. Our findings verify the conclusions of Warren et al, 13 who reported the presence of transmural lymphoid aggregates in excised defunctioned rectums in a much smaller group of patients with ulcerative colitis. They noted no relationship between this phenomenon and Crohn's disease-like outcomes.…”

“…They noted no relationship between this phenomenon and Crohn's disease-like outcomes. The present study differed from that of Warren et al 13 by including patients with Crohn's disease and indeterminate colitis and by having much longer clinical follow-up (median, 57 vs. 22 months).…”

“…1,[3][4][5][6][7][8][9]11,12 However, many of the current studies of the histology of the defunctioned colorectum specifically excluded patients with inflammatory bowel disease, investigated small numbers of patients, and had relatively short follow-up. In 1993, Warren et al 13 noted transmural lymphoid aggregates in excised defunctioned rectums in 9 of 15 patients after subtotal colectomy for ulcerative colitis. The authors concluded that the presence of transmural lymphoid aggregates did not indicate Crohn's disease.…”

The Fate of the Ileal Pouch in Patients Developing Crohn's Disease

“…1 This group of patients may represent a subset of Crohn's disease that is limited to the colon or has a nonrecurring variety of Crohn's disease. Although there is histologic similarity between defunctionalized ulcerative colitis and Crohn's disease, 18 the possibility exists that the diagnosis of Crohn's disease based on the diverted rectum is the correct one. One patient in our series required pouch excision after developing fulminant anal Crohn's dis- ease in the setting of a previously diverted rectal specimen containing granulomas.…”

MicroRNA expression patterns in indeterminate inflammatory bowel disease

“…Diverted rectal specimens were not used to differentiate ulcerative colitis and Crohns disease, due to their well reported tendency to nonspecifically mimic the transmural features of Crohns disease. [13][14][15][16] …”