Confocal laser endomicroscopy for the diagnosis of diversion colitis

This paper reports a single case of a 33-year-old woman with longstanding symptoms of diarrhea after ileocecal resection and colorectal diversion performed for complicated ileocecal and rectal endometriosis, poor wound healing, and a rectovaginal fistula. After high definition white-light endoscopy showed markedly inflamed, friable mucosa with large ulcerations and pus, the authors used fluorescein-guided confocal laser endomicroscopy to identify pronounced crypt rarefaction, hypervascularization with moderate leakage, and typical crypt abscesses, findings confirmed by conventional histopathology; they also noted no evidence of cytomegalovirus by specific staining. A subsequent i-Scan evaluation about 10 weeks later showed endoscopic improvement after topical salicylate therapy, which the authors used to support the diagnosis and management pathway. This paper is centrally about endometriosis’ postoperative consequences — it describes diversion colitis arising after bowel surgery performed for complicated ileocecal and rectal endometriosis.

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