Ileocecal Valve Nsaid

Fig. 12.39 Atypical ulcer on base of cecum without wider endoluminal reaction in the surrounding area. At the base of the ulcer, visible fibers of the lamina propria of the cecal wall. A perforation later developed at this location after colonoscopy. Intraoperative and pathological-anatomical widespread ischemia with hemorrhaging of outer colon wall.

Fig. 12.40 Differential diagnosis (ischemia vs. non-Hodgkin lymphoma): similar to ischemia, maplike appearance with surface ulcerations, but also with nodular elements: segmental organ involvement in sigmoid colon of non-Hodgkin lymphoma (low-grade, follicular type).
Ascending Colon Location

Fig. 12.41 Erosive changes in ascending colon in NSAID colitis.

Ascending Colon Ulcer

Fig. 12.42 Solitary ulcer in ascending colon: NSAID colitis.

Fig. 12.41 Erosive changes in ascending colon in NSAID colitis.

Fig. 12.42 Solitary ulcer in ascending colon: NSAID colitis.

Fig. 12.43 Ulceration on the ileocecal valve (= typical predilection location) in NSAID colitis, surrounding area unaffected.

Nsaid Colitis
Fig. 12.44 Ulcer on ileocecal valve in NSAID colitis. Ulcer is characteristically flat, without well-delineated margin or reaction at margin.
Nsaid Colitis Histology

Fig. 12.45 Atrophy due to NSAID colitis.

a Residual condition after prior chronic NSAID colitis (right transverse colon), bizarre spiral-shaped scarring with segmental stenoses. b Atrophy processes could lead to "buttonhole" stenoses (hepatic flexure).

Fig. 12.45 Atrophy due to NSAID colitis.

a Residual condition after prior chronic NSAID colitis (right transverse colon), bizarre spiral-shaped scarring with segmental stenoses. b Atrophy processes could lead to "buttonhole" stenoses (hepatic flexure).

Fig. 12.47 Diversion colitis: moderate reddening and loss of normal vessel pattern, mild edema (ascending colon).

Fig. 12.48 Diversion colitis: atypical vessels (ascending colon).

Fig. 12.47 Diversion colitis: moderate reddening and loss of normal vessel pattern, mild edema (ascending colon).

Fig. 12.48 Diversion colitis: atypical vessels (ascending colon).

NSAID Colitis

Like ischemic colitis, the incidence of NSAID colitis is on the rise. The increase is attributed to a significant rise in long-term use of nonsteroidal anti-inflammatory drugs and salicylates. Consideration of NSAID colitis as a possible diagnosis is a vital when diagnosing IBD, especially among older individuals.

NSAID colitis typically affects the right side. Lesions can range from aphthous erosions to broad-based ulcerations, without deep infiltration of the wall (Figs. 12.41, 12.42). The area around the ileocecal valve is quite often affected, in many cases by a broad, solitary ulcer (Figs. 12.43, 12.44). The surrounding area often appears normal and the ulcer margins do not show any significant reaction. However, there can be inflammation in areas that appear virtually unaffected macroscopically. Multiple biop

Diversion Colitis

-Double-barreled colostomy, descending colon

Fig. 12.46 Localization of diversion colitis.

-Double-barreled colostomy, descending colon

Area affected by diversion colitis

Fig. 12.46 Localization of diversion colitis.

sies from the entire colon are therefore advisable, since right-sided proliferation can be further confirmed histologi-cally. Pronounced scarring may be present (Fig. 12.45). Today, NSAID colitis is the most important alternative diagnosis (differential diagnosis) to Crohn disease, especially among older patients.

Diversion Colitis

Diversioncolitis occurs in so-called shut down large intestinal segments (Fig. 12.46). The pathogenesis is not clear. Diversion colitis can be totally asymptomatic, only discovered when, for example, the colon is inspected before restoration following temporary diversion of the fecal stream. Recurrent bleeding can also occur.

^¿k The appearance can be similar to UC, with areas of lym-phoid hyperplastic tissue (Figs. 12.47,12.48). Only very rarely does stenosis appear in diversion colitis. Its presence usually prevents endoscopic therapy.

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Responses

  • gustava ferri
    What is solitary ulcer in ascending colon?
    8 years ago
  • vihtori
    What are valve ulcers located in the colon?
    7 years ago

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