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Progression of ulcerative colitis following diversion colitis

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Abstract

Diversion colitis and ulcerative colitis (UC) can be caused by different mechanisms; however, several case reports have described the development of typical UC following diversion colitis. A 63-year-old man underwent Hartmann’s operation following a diagnosis of perforation of a sigmoid colon diverticulum and peritonitis. Stoma closure was performed 4 months later, and the portion of the sigmoid colon with the diverticulum was unintentionally left as a blind end. Following stoma closure, hematochezia worsened, and he was diagnosed as having developed diversion colitis only in the blind sigmoid colon. Intermittent use of topical mesalazine enemas controlled the bowel symptoms; however, 4 years after the stoma closure, bloody stools were observed again. Colonoscopy revealed coarse and friable granular mucosa with adherent mucopurulent exudate in the rectum, and mucosal erythematous edema with adherent mucopurulent exudate in the blind sigmoid colon. The histological findings indicated basal plasmacytosis, and goblet cell depletion and cryptitis in the lamina propria, which is characteristic of UC. To the best of our knowledge, this is the fourth description of a patient who developed UC following diversion colitis. Local inflammation may have triggered the development of UC through hematogenous or lymphogenous circulation of lymphocytes or autoantibodies.

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Abbreviations

UC:

Ulcerative colitis

SCFA:

Short chain fatty acid

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Acknowledgements

We thank Jane Charbonneau, DVM, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

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The authors have not disclosed any funding.

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Author notes

  1. Katsuki Yaguchi and Yusuke Matsune contributed equally to this work.

Authors and Affiliations

  1. Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urafune-cho Minami-ku, Yokohama, 232-0024, Japan

    Katsuki Yaguchi, Yusuke Matsune, Reiko Kunisaki, Kentaro Araki & Hideaki Kimura

  2. Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Katsuki Yaguchi, Reiko Kunisaki & Shin Maeda

  3. Department of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan

    Yoshiaki Inayama

  4. Department of Pathology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan

    Jiro Kumagai

Authors
  1. Katsuki Yaguchi
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  2. Yusuke Matsune
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  4. Kentaro Araki
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Contributions

KY, MY, and RK: literature search, data collection and interpretation, and manuscript writing. KA, HK, YI, and SM: interpretation and critical revision of the manuscript. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Reiko Kunisaki.

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Yaguchi, K., Matsune, Y., Kunisaki, R. et al. Progression of ulcerative colitis following diversion colitis. Clin J Gastroenterol 15, 1088–1093 (2022). https://doi.org/10.1007/s12328-022-01696-4

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  • DOI: https://doi.org/10.1007/s12328-022-01696-4

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