{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T21:26:17Z","timestamp":1770153977119,"version":"3.49.0"},"reference-count":14,"publisher":"BMJ","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1993,4]]},"abstract":"<jats:p>Faecal stream diversion may induce inflammatory changes in the defunctioned segment of the large intestine. These changes are predominantly mucosal, although confusing histological features including granulomas may be present. The pathology of 15 defunctioned rectal stumps has been studied. All patients had previously undergone urgent total colectomy for ulcerative colitis and rectal stumps had been left in situ while they awaited pelvic ileal reservoir construction. All rectal stumps showed predominantly mucosal disease but there were additional features such as florid lymphoid follicular hyperplasia (12 cases), transmural inflammation (nine cases), granulomas (four cases), fissures (eight cases), and changes akin to ischaemia or to pseudomembraneous colitis (four cases). These changes may result from a combination of defunctioning and of active ulcerative proctitis. Some induce a histological appearance that may mimic Crohn's disease. Nevertheless review of all 15 colectomy specimens showed unequivocal ulcerative colitis and none of the patients has subsequently shown any clinical, radiological, or pathological evidence to support a diagnosis of Crohn's disease. Histology of the rectal stump in ulcerative colitis may lead to an erroneous diagnosis of Crohn's disease and the patient may subsequently be denied the advantage of a pelvic ileal reservoir.<\/jats:p>","DOI":"10.1136\/gut.34.4.514","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"514-516","source":"Crossref","is-referenced-by-count":61,"title":["Pathology of the defunctioned rectum in ulcerative colitis."],"prefix":"10.1136","volume":"34","author":[{"given":"B F","family":"Warren","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N A","family":"Shepherd","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D C","family":"Bartolo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J W","family":"Bradfield","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1993,4,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1056\/NEJM198901053200105","article-title":"Treatment of diversion colitis with short chain fatty acid irrigamatory and giant cell reaction to ruptured crypts tion","volume":"320","author":"Harig, J.M.; Soergel, K.H.; Komorowski, R.A.; Wood, C.M.","year":"1989","unstructured":"Harig JM, Soergel KH, Komorowski RA, Wood CM. Treatment of diversion colitis with short chain fatty acid irrigamatory and giant cell reaction to ruptured crypts tion. New Engli] Med 1989; 320: 23-38.","journal-title":"New Engli] Med"},{"key":"ref_2","article-title":"Diversion colitis: a clinicopseudomembraneous colitis like lesions may be pathological study of 21 cases. Hum Pathol 1990; 21: 429-36. seen in ischaemic colitis","volume-title":"II The changes","author":"Ma, C.K.; Gottlieb, C.; Haas, P.A.","unstructured":"Ma CK, Gottlieb C, Haas PA. Diversion colitis: a clinicopseudomembraneous colitis like lesions may be pathological study of 21 cases. Hum Pathol 1990; 21: 429-36. seen in ischaemic colitis. II The changes"},{"key":"ref_3","first-page":"438","article-title":"Proctitis and colitis described in this study are a likely consequence following diversion of the faecal stream. Gastroenterology of pre-existing ulcerative proctitis with super-","volume":"80","author":"Glotzer, D.J.; Glick, M.E.; Goldman, H.","year":"1981","unstructured":"Glotzer DJ, Glick ME, Goldman H. Proctitis and colitis described in this study are a likely consequence following diversion of the faecal stream. Gastroenterology of pre-existing ulcerative proctitis with super- 1981; 80: 438-41."},{"key":"ref_4","article-title":"Diversion colitis imposed defunctioned proctitis, possibly with and involution of the defunctioned anorectum. Gut 1990; 31: mild mucosal ischaemia as an additional patho- A1 174","author":"Roe, A.M.; Warren, B.F.; Brodribb, Brown; C.","unstructured":"Roe AM, Warren BF, Brodribb, Brown C. Diversion colitis imposed defunctioned proctitis, possibly with and involution of the defunctioned anorectum. Gut 1990; 31: mild mucosal ischaemia as an additional patho- A1 174."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1136\/gut.29.5.561","article-title":"Progress with the pouch - restorative proctocolectomy for ulcerative colitis","volume":"29","author":"Mortensen, N.","year":"1988","unstructured":"Mortensen N. Progress with the pouch - restorative proctocolectomy for ulcerative colitis. Gut 1988; 29: 561-5.","journal-title":"Gut"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1002\/bjs.1800720622","article-title":"Restorative protocolectomy with ileal 4.-.. reservoir for ulcerative colitis and familial adenomatous polyposis: a comparison of three reservoir designs","volume":"72","author":"Nicholls, R.J.; Pezim, M.E.","year":"1985","unstructured":"Nicholls RJ, Pezim ME. Restorative protocolectomy with ileal 4.-.. reservoir for ulcerative colitis and familial adenomatous polyposis: a comparison of three reservoir designs. Br] Surg 1985; 72: 470-4.","journal-title":"Br] Surg"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1136\/gut.31.3.247","article-title":"Inflammation in ileal reservoirs: pouchitis","volume":"31","author":"Madden, M.V.; Farthing, M.J.G.; Nicholls, R.J.","year":"1990","unstructured":"Madden MV, Farthing MJG, Nicholls RJ. Inflammation in ileal reservoirs: pouchitis. Gut 1990; 31: 247-9.","journal-title":"Gut"},{"key":"ref_8","article-title":"In: Symposium: restorative proctocolectomy with ileal reservoir","author":"Pathophysiology, Moskowitz R.L.","year":"1986","unstructured":"Moskowitz RL. Pathophysiology. In: Symposium: restorative proctocolectomy with ileal reservoir. Intl] Colorect Dis 1986;","journal-title":"Intl] Colorect Dis"},{"key":"ref_9","first-page":"267","article-title":"Histopathology of Crohn's disease","volume-title":"bowel diseases","author":"Thompson, H.","year":"1990","unstructured":"Thompson H. Histopathology of Crohn's disease. In: Allan RN, Keighley MRB, Alexander-Williams J, Hawkins C, eds. Inflammatory bowel diseases. London: Churchill Livingstone 1990: 267-8."},{"key":"ref_10","first-page":"1","article-title":"Pseudomembranous colitis","volume":"30","year":"1977","unstructured":"Price AB, Davies DR. Pseudomembranous colitis. ] (,lin Pathol 1977; 30: 1-12."},{"key":"ref_11","article-title":"The large intestine","volume-title":"oesophageal pathology","author":"Gratama, S.","unstructured":"Gratama S. The large intestine. In: Whitehead R, ed. Gastrointestinal and oesophageal pathology. London: Churchill Livingstone 1989: 586."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1007\/BF01658047","article-title":"Proctocolectomy and ileoanal anastomosis","volume":"12","author":"Beart, R.W.","year":"1988","unstructured":"Beart RW. Proctocolectomy and ileoanal anastomosis. World Surg 1988; 12: 160-63.","journal-title":"World Surg"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1056\/NEJM198005083021906","article-title":"Surgical management of Crohn's colitis","volume":"302","author":"Block, G.E.","year":"1980","unstructured":"Block GE. Surgical management of Crohn's colitis. New Engi ] Med 1980; 302: 1068-70.","journal-title":"New Engi"},{"key":"ref_14","first-page":"57","article-title":"The pelvic ileal reservoir: pathology and pouchitis","volume":"37","author":"Shepherd, N.A.","year":"1990","unstructured":"Shepherd NA. The pelvic ileal reservoir: pathology and pouchitis. Neth]r Med 1990; 37: S57-S64.","journal-title":"Neth]r Med"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.34.4.514","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T16:08:42Z","timestamp":1765642122000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.34.4.514"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1993,4]]},"references-count":14,"journal-issue":{"issue":"4","published-online":{"date-parts":[[1993,4,1]]},"published-print":{"date-parts":[[1993,4]]}},"alternative-id":["10.1136\/gut.34.4.514"],"URL":"https:\/\/doi.org\/10.1136\/gut.34.4.514","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1993,4]]}}}