Acute Self-limited Colitis
Definition
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Inflammation of the colon due to infectious organisms, generally short term
Diagnostic Criteria
- Predominantly acute inflammation largely restricted to lamina propria
- Neutrophilic involvement of crypt epithelium may be seen
- Crypt abscesses may be seen
- May be patchy or diffuse
- Lacks chronic changes of inflammatory bowel disease
- Minimal to no crypt distortion or drop out
- Mild to no chronic inflammatory infiltrate in lamina propria
- Persistent and severe infections may lead to mild crypt distortion
- Severe cases may lead to ulceration, hemorrhage and microthrombi
- Common causes include:
- Campylobacter jejunalis
- May have prominent macrophage infiltrate
- Salmonella
- Lacks mucus depletion except in severe cases
- May have prominent macrophage infiltrate with erythrophagocytosis
- Shigella
- Mucus depletion
- Aphthous ulcers over lymphoid follicles
- Severe cases may ulcerate with a pseudomembrane
- Yersinia
- May have aphthous ulcers
- May have necrotic granulomas
- May have prominent follicular hyperplasia
- About half of cases have no identifiable bacterial cause
- Many such cases are viral
- Stool ova and parasite examination is necessary to rule out parasitic cause
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342
Original posting : November 11, 2009
Differential Diagnosis
| Ulcerative Colitis |
Acute Self-limited Colitis |
| Basal lymphoid aggregates frequent |
Basal lymphoid aggregates absent |
| Neutrophil infiltrate in crypts with frequent crypt abscesses |
Neutrophil infiltrate predominantly in lamina propria |
| Inflammation involves all levels of mucosa |
Inflammation largely restricted to upper and mid zones of mucosa |
| Architectural changes of chronic colitis are present |
Architecture is preserved |
| Duration at least 6 months |
Short duration |
Common organisms include Salmonella, Shigella, Campylobacter, Yersinia and viruses
| Incidental Chronic Colitis |
Acute Self-limited Colitis |
| Isolated disease, virtually restricted to cecum/right colon |
Usually multifocal or extensive |
| Histologic changes of chronic colitis present |
Changes of chronic colitis rare |
| Incidental, asymptomatic |
Nearly always symptomatic |
Separation of severe cases from ischemic colitis and pseudomembranous colitis requires identification of the organism
Bibliography
Noffsinger A, Fenoglio-Preiser CM, Maru D, Gilinisky N. Gastrointestinal Diseases, AFIP Atlas of Nontumor Pathology, First Series, Fascicle 5, 2007.
Greenson JK, Stern RA, Carpenter SL, Barnett JL. The clinical significance of focal active colitis. Hum Pathol. 1997 Jun;28(6):729-33.
McGovern VJ, Slavutin LJ. Pathology of salmonella colitis. Am J Surg Pathol. 1979 Dec;3(6):483-90.
Day DW, Mandal BK, Morson BC. The rectal biopsy appearances in Salmonella colitis. Histopathology. 1978 Mar;2(2):117-31.
Sachdev HP, Chadha V, Malhotra V, Verghese A, Puri RK. Rectal histopathology in endemic Shigella and Salmonella diarrhea. J Pediatr Gastroenterol Nutr. 1993 Jan;16(1):33-8.
Colgan T, Lambert JR, Newman A, Luk SC. Campylobacter jejuni enterocolitis. A clinicopathologic study. Arch Pathol Lab Med. 1980 Nov;104(11):571-4.
Gleason TH, Patterson SD. The pathology of Yersinia enterocolitica ileocolitis. Am J Surg Pathol. 1982 Jun;6(4):347-55.
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