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Background
This is a colitis that occurs in segments of bypassed colonic tissue, occurring after surgical diversion of the fecal stream. It resolves with restoration of colonic continuity. Colonic diversion is a common procedure utilized in the treatment of many conditions inlcuding colonic neoplasms, diverticulitis, trauma, Hirschsprung's, inflammatory bowel disease, and obstruction. The majority of patients are asymptomatic but about 20-30% of patients develop abdominal pain, rectal discharge, or bleeding, usually occurring from one month to three years after the diversion procedure.
Outline
Epidemiology
Pathogenesis
Laboratory/Radiologic/Other Diagnostic Testing
Gross Appearance and Clinical Variants
Histopathological Features and Variants
Differential Diagnosis
Prognosis and Treatment
Commonly Used Terms
EPIDEMIOLOGY CHARACTERIZATION A prospective evaluation of diversion colitis.
Ferguson CM, Siegel RJ.
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Am Surg 1991 Jan;57(1):46-9 Abstract quote
Numerous case reports suggest that diversion of the fecal stream results in nonspecific colitis, with abnormalities ranging from minimal friability to gross ulceration. Published reports consist largely of patients with symptomatic colitis, and there are scant data suggesting at what frequency diversion colitis actually occurs.
In an attempt to identify the frequency of diversion colitis and any associated etiologic factors, 20 patients scheduled for colostomy closure at Grady Memorial Hospital between 8/1/88 and 6/15/89 underwent colonoscopy, including the excluded segment, to evaluate for diversion colitis. Colostomies were performed for the management of diverticulitis, trauma, cancer, protection of an anastomosis, and diversion of fecal fistula. Patients with ulcerative colitis or Crohn's disease were excluded. The colon was classified grossly as normal or colitis (including easy friability, edema, inflammation, and ulceration as colitis). Fourteen of the 20 patients (70%) had findings of diversion colitis (DC), while six had a normal exam (NL). Nine biopsies were performed in the DC group and all revealed microscopic abnormalities. One of the normal patients was also biopsied, revealing mild, nonspecific changes. There was no difference in mean age (DC 49.3, NL 48.2), interval from formation of colostomy (DC 9.21 +/- 7.27 months, NL 2.83 +/- 1.94 months), type of colostomy, or reason for colostomy in the two groups. None of the DC patients had symptoms of colitis (mucous or bloody discharge, tenesmus, or pain), and one of the DC patients manifested symptoms of colitis after colostomy closure.
We conclude that diversion colitis is a common subclinical problem in patients with a diverting colostomy.
DISEASE ASSOCIATIONS CHARACTERIZATION Diversion colitis in patients with myelopathy: clinical, endoscopic, and histopathological findings.
Frisbie JH, Ahmed N, Hirano I, Klein MA, Soybel DI.
Department of Medicine, Department of Veterans Affairs Medical Center, West Roxbury, MA 02132, USA.
J Spinal Cord Med 2000 Summer;23(2):142-9 Abstract quote
OBJECTIVE: One of the problems with a diverting colostomy, applied in patients with myelopathy for complications of the neuropathic large bowel, is diversion colitis. A clinical, endoscopic, and histological survey was conducted to describe the problem in these patients.
METHODS: 19 patients with myelopathy who have had colostomies (68% of those available) participated in the survey. History of rectal discharge and perineal ulceration plus colonoscopic and biopsy observations were recorded. 20 patients with myelopathy who have not had colostomies, with clinically indicated colonoscopic examinations, were compared for skin breakdown and endoscopic appearance.
RESULTS: 15 patients who had colostomies (79%) reported rectal discharge, and 9 (47%) sustained perineal ulceration, 2 being recurrent and refractory. None of the 20 patients who had not had colostomies had perineal ulceration (p = 0.04). Colonoscopy revealed mucosal erythema and friability in 18 patients (94%) with a predominance in the rectosigmoid colon. 1 of 20 without colostomy presented with this picture (p < 0.001). Mucosal biopsies of diverted colon revealed chronic inflammation in all patients, severe inflammation in 13 of 19 subjects at < or = 20 cm from the anus, and in 3 of 10 at > 20 cm (p = 0.06). No difference in the severity of inflammation with time, 0 to 2 years versus > 2 to 18 years post colostomy, could be demonstrated.
CONCLUSIONS: Diversion colitis is a frequent, persistent, and sometimes problematic complication in patients with myelopathy who have also had colostomies.
PATHOGENESIS CHARACTERIZATION Nitrate-reducing bacteria in diversion colitis: a clue to inflammation?
Neut C, Guillemot F, Colombel JF.
Laboratoire de Bacteriologie, Faculte de Pharmacie, Lille, France.
Dig Dis Sci 1997 Dec;42(12):2577-80 Abstract quote
A pathogenic role of nitric oxide has been suggested in acute and chronic intestinal inflammation. We took the opportunity offered by studies in patients with excluded colon, which represents a model of chronic intestinal inflammation with no exogenous nitrite or nitrate supply, to evaluate the quantity and the quality of nitrate reducers in diversion colitis.
Thirty patients (17 men, 13 women, mean age 45 years) having an excluded colon for various reasons were sampled by rectal swabs and compared to 30 healthy controls (11 men, 19 women, mean age 28 years). The percentage of nitrate-reducers among the total count of subcultured bacteria was 46 +/- 41% (mean +/- SD) in patients with diversion colitis as compared to 19 +/- 24% in healthy controls. This difference was significant (P < 0.05) despite great heterogeneity in individual values. In patients with diversion colitis, 75/254 (29.5%) different isolated bacterial strains were nitrate-reducers as compared to 61/294 (21%) (P < 0.05) in controls. Among the 75 nitrate-reducing strains isolated from patients with diversion colitis, 55 were aerobes. Pseudomonas species were only encountered in this population. The predominant group was enterobacteria with a high isolation rate of species belonging to the genera Proteus, Providencia, and Morganella. In healthy controls nitrate-reducing anaerobes were nearly as frequent as aerobes. The most frequent species was Eubacterium lentum, followed by Clostridium perfringens.
It could be suggested that nitric oxide synthase might produce a bacterial substrate increasing the growth of bacteria with a high pathogenic potential, creating conditions for chronic inflammation and infection in patients with excluded colon.
LABORATORY/RADIOLOGIC/
OTHER TESTSCHARACTERIZATION RADIOLOGIC Lymphoid follicular hyperplasia in excluded colonic segments: a radiologic sign of diversion colitis.
Lechner GL, Frank W, Jantsch H, Pichler W, Hall DA, Waneck R, Wunderlich M.
Department of Radiology, University of Vienna, Austria.
Radiology 1990 Jul;176(1):135-6 Abstract quote
Double-contrast barium enema (DCBE) studies showed lymphoid follicular hyperplasia (LFH) in excluded colonic segments after colostomy in 12 of 40 patients. In most patients with LFH, more than 80% of the excluded colon was affected. In eight patients, regression of LFH was demonstrated with DCBE studies after reanastomosis.
This work suggests that LFH is the most common DCBE study finding in diversion colitis.
GROSS APPEARANCE/
CLINICAL VARIANTSCHARACTERIZATION Aphthous ulceration in diversion colitis. Clinical implications.
Lusk LB, Reichen J, Levine JS.
Gastroenterology 1984 Nov;87(5):1171-3 Abstract quote
Two cases of aphthous ulceration apparently due to diversion colitis are described. There was no evidence of Crohn's disease initially or at follow-up. Aphthous ulceration of the colon and diversion colitis are reviewed, and the nonspecificity of aphthae for Crohn's disease is stressed. The presence of aphthous ulcers in a diverted colon should not preclude colostomy closure.
HISTOLOGICAL TYPES CHARACTERIZATION Diversion colitis: a clinicopathologic study of 21 cases.
Ma CK, Gottlieb C, Haas PA.
Department of Pathology, Henry Ford Hospital, Detroit, MI 48202.
Hum Pathol 1990 Apr;21(4):429-36 Abstract quote
Inflammation occurring in a defunctionalized portion of bowel, following either ileostomy or colostomy, has long been recognized by endoscopists. However, little has been written about this entity, particularly the histopathologic changes. Glotzer et al in 1981 described 10 cases, and coined the term "diversion colitis".
We studied 21 patients without previous history of inflammatory bowel disease who, for reasons including perforated diverticulitis, carcinoma, or trauma, had loop colostomies or Hartmann's procedure performed. Many of these patients became symptomatic with complaints related to the defunctionalized bowel, including rectal discomfort, pain, discharge, and bleeding. Nineteen patients had endoscopic examinations, which revealed a variety of findings including mucous plugs, friability, petechia, erythema, ulcers, exudate, and nodules or polyps. All except one case had tissue from the excluded portions of bowel available for pathologic examination.
Most displayed nonspecific changes with mild-to-moderate lymphoplasmacytic infiltrates in the lamina propria, mild architectural alterations of the crypts, and slight decrease in crypt numbers. Ulceration, cryptitis, and crypt abscesses simulating ulcerative colitis were uncommon findings and were observed almost exclusively in more severe cases. Granulomas were observed in two cases, raising the possibility of Crohn's disease.
Histologic spectrum of diversion colitis.
Komorowski RA.
Department of Pathology, Medical College of Wisconsin, Milwaukee.
Am J Surg Pathol 1990 Jun;14(6):548-54 Abstract quote
Biopsy specimens taken from six patients with diversion colitis, an inflammatory process that occurs in the bypassed colonic segment after diversion of the fecal stream, showed a spectrum of histologic changes ranging from mild colitis to those seen in severe active chronic ulcerative colitis. Histologic abnormalities included aphthous ulcers, crypt distortion, atrophy and abscesses, a villous colonic surface, and a mixed acute and chronic inflammatory infiltrate with patchy lymphoid hyperplasia.
Accurate pathologic diagnosis is dependent on clinical history, comparison of histologic morphology in both colonic segments, and response to therapy with local application of short chain fatty acids.
Lymphoid follicular hyperplasia--a distinctive feature of diversion colitis.
Yeong ML, Bethwaite PB, Prasad J, Isbister WH.
Department of Pathology, Wellington School of Medicine, New Zealand.
Histopathology 1991 Jul;19(1):55-61 Abstract quote
Diversion colitis refers to the inflammatory changes that occur in the defunctioned segment of the large intestine following diversion of the faecal stream.
We report the histological features in the defunctioned rectums from seven patients: one each with severe constipation and Behcet's disease, two with Crohn's disease with rectal sparing and three with ulcerative colitis. The appearances of diversion colitis in a previously normal rectum are compared with diversion colitis with superimposed inflammatory bowel disease. Lymphoid follicular hyperplasia was found in all cases. This was marked in patients with inflammatory bowel disease, with or without initial rectal involvement. Other changes comprised surface epithelial degeneration and ulceration, mucosal inflammation including crypt abscesses, and crypt branching. Inflammatory and crypt changes were mild, except in ulcerative colitis where changes were marked and resembled those of the proximal colon.
Lymphoid hyperplasia is a distinctive feature in diversion colitis. The term follicular proctitis, previously used to indicate chronic ulcerative colitis exclusively, should be re-examined.
Diversion colitis: histological features in the colon and rectum after defunctioning colostomy.
Geraghty JM, Talbot IC.
Department of Pathology, St Mark's Hospital, London.
Gut 1991 Sep;32(9):1020-3 Abstract quote
Diversion of the faecal stream by ileostomy or colostomy leads to inflammation in the defunctioned segment, known as diversion colitis. The affected bowel is rapidly restored to normality by reanastomosis. Diversion colitis should not be mistaken for inflammatory bowel disease, for which reanastomosis would be inappropriate. Studies of biopsy material from patients with diversion colitis have shown a variety of histological features, but no consistent pattern.
The histology in resection specimens of defunctioned large bowel from 15 patients with no pre-existing inflammatory bowel disease was studied. Nine patients had symptoms of abdominal pain or rectal discharge of blood or mucus that developed between 9 months and 17 years after diversion procedure. The histology was abnormal in all. Findings were similar in 14 patients, regardless of the duration of faecal diversion, and comprised diffuse mild chronic inflammation with or without mild crypt architectural abnormalities, crypt abscesses, or follicular lymphoid hyperplasia. One patient had more severe changes, resembling active ulcerative colitis.
These features in biopsy specimens are unlikely to be diagnostic but should provide useful information in avoiding a mistaken diagnosis of inflammatory bowel disease in these patients.
The morphologic features of diversion colitis: studies of a pediatric population with no other disease of the intestinal mucosa.
Haque S, Eisen RN, West AB.
Department of Pathology, Yale University, New Haven, CT 06510-8070.
Hum Pathol 1993 Feb;24(2):211-9 Abstract quote
Studies of diversion colitis have not shown a consistent pattern of histopathologic features, and many descriptions are difficult to interpret because of the presence of underlying intestinal mucosal disease.
To define the histologic changes in patients free of other mucosal inflammatory disease, we studied the resected segments of bypassed colorectum from 37 patients with Hirschsprung's disease treated by a two-stage procedure, using rectal biopsy specimens taken for initial diagnosis and trimmings from proximal to the stoma as controls. Biopsy specimens from a further 14 patients of similar age but without colorectal mucosal disease were used as additional controls. The histology of the bypassed segment was abnormal in all patients. Twenty-six had diversion colitis characterized by diffuse follicular lymphoid hyperplasia; lamina propria expansion by plasma cells, lymphocytes, and some neutrophils; cryptitis; reactive epithelium; and mucin depletion. Crypt abscesses, aphthous ulcers, mild architectural distortion, and Paneth cell metaplasia were noted in more severe cases. The remaining 11 patients had mild follicular lymphoid hyperplasia and an increase in lymphoplasmacytic infiltrates, with absence of neutrophils, epithelial injury, and other changes seen in diversion colitis, a pattern we term "diversion reaction." Diversion colitis is common in children with a bypassed colorectum. It can be distinguished histologically from other mucosal diseases in most cases.
We hypothesize that diversion reaction may be an inevitable consequence of colonocyte nutrient deficiency and that diversion colitis may be superimposed by a second insult, such as a low-grade pathogen.
Diversion colitis. A prospective study.
Whelan RL, Abramson D, Kim DS, Hashmi HF.
Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032.
Surg Endosc 1994 Jan;8(1):19-24 Abstract quote
A prospective study of patients who had undergone fecal diversion was performed in order to determine the incidence of and to characterize better the condition known as "diversion colitis."
A total of 53 patients were studied. All patients underwent endoscopic evaluation of the diverted large bowel. Evidence of colitis was found in 48 patients (91%). The colitis was mild in 52%, moderate in 44%, and severe in only 4%. Endoscopic findings included: contact irritation or bleeding, erythema, and mucosal nodularity. The proximal, "in continuity," colon was examined in 86% of patients with colostomies; none were found to have colitis.
Biopsies were taken of the diverted segment in 94% of patients with colitis and from the "in continuity" colon in 78% of patients with colostomies. Similar histologic findings were noted on these biopsies and included: mild chronic inflammation, lymphoid nodules, and crypt architectural changes. With the exception of lymphoid nodules, which were seen more frequently in the inflamed diverted colon (P = 0.035), there was no significant difference in the incidence of the various histologic changes when the biopsies from the diverted and "in continuity" large bowel were compared. Rectal washings and stool samples were sent for bacterial cultures, ova, and parasite analysis, and C. Diff. toxin titers in the majority of patients; all but 1 were negative. Symptoms relating to the diverted bowel were elicited in only 3 patients (6%). Stomal closure was carried in 70% of patients. Postclosure endoscopy in 21 patients revealed full resolution of the colitis in all.
Diversion colitis occurs in almost all diverted patients. It uniformly resolves following stomal closure
Mucosal inflammation in pediatric diversion colitis: a quantitative analysis.
Grant NJ, Van Kruiningen HJ, Haque S, West AB.
Department of Pathobiology, University of Connecticut, Storrs 06269-3089, USA.
J Pediatr Gastroenterol Nutr 1997 Sep;25(3):273-80 Abstract quote
BACKGROUND: Diversion colitis commonly occurs in bypassed segments of colorectum, and has been described qualitatively in Hirschsprung's disease patients with colostomies. The objective of this study was to characterize quantitatively the changes in the inflammatory cell population in the mucosa of children with diversion colitis.
METHODS: Paraffin blocks of well-oriented, full-thickness colorectal tissues were obtained from 15 children with diversion colitis (all with Hirschsprung's disease), four pediatric controls and four adult controls. Sections were immunostained for B and T lymphocytes, macrophages, IgG, IgM, and IgA. Measurements were made referent to a standard length of muscularis mucosae. Lymphoid follicles were counted and the areas occupied by B and T cells were determined by image analysis. Cells in the interfollicular lamina propria were counted separately, but IgA-containing plasma cells were too abundant to enumerate.
RESULTS: Pediatric diversion colitis was characterized by enlarged and more numerous lymphoid follicles with approximately four times as many B lymphocytes and twice as many T lymphocytes in the follicular compartment of the mucosa when compared to pediatric controls. The interfollicular mucosa was thickened (499 +/- 27 versus 380 +/- 56 microns) and contained approximately six times as many B cells and eight times as many T cells as controls. Macrophages and plasma cells containing IgG and IgM were not significantly increased.
CONCLUSIONS: These findings extend the qualitative observations of increased follicular and lamina propria lymphoid tissue in bypassed segments of colon, and are consistent with the hypothesis of persistent antigenic stimulation of the mucosa-associated lymphoid tissue.
Human defunctionalized colon: a histopathological and pharmacological study of muscularis propria in resection specimens.
Violi V, Cobianchi F, Adami M, Torri T, Ferraro G, Roncoroni L.
Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, University of Parma Medical School, Italy.
Dig Dis Sci 1998 Mar;43(3):616-23 Abstract quote
Despite the regression of "diversion colitis," temporary functional disorders after bowel continuity restoration could be caused by changes in the smooth muscle of excluded segments; however, studies on the muscularis propria have yielded contradictory results.
This study was aimed at evaluating possible histopathological changes in muscular layers and motility of the defunctionalized human colon. Ten patients with defunctionalized colorectum (group A) and 10 controls (group B) underwent restorative or primary resection surgery. Strips were taken proximal to the colostomy (specimens A1) and the defunctionalized segment (specimens A2), and from the proximal (specimens B1) and distal extremity (specimens B2) of resected colons. Measurements of the thickness of the muscularis propria and of the volume density of the myenteric plexus, as well as of spontaneous motility and responses to electrical and pharmacological stimulation were taken. The muscularis propria was thicker in A2 than in A1 specimens (P = 0.004) and in B2 than in B1 specimens (P = 0.007).
No differences were recorded either in the myenteric plexus volume density or in colonic motility. No differences were recorded in intergroup comparisons. As no structural or functional changes related to defunctionalization were found, clinical disorders after colorectal restoration could rather result from underlying colonic pathology and/or incomplete distal colon resection.
Diversion colitis in children: an iatrogenic appendix vermiformis?
Vujanic GM, Dojcinov SD.
Department of Pathology, University of Wales College of Medicine, Cardiff, UK.
Histopathology 2000 Jan;36(1):41-6 Abstract quote
AIMS: Diversion colitis (DC) is a localized, relatively benign, iatrogenic condition which occurs in almost 100% of diverted colonic segments in patients who undergo ileostomy/colostomy for various reasons. The aim of this study was to establish histological features of DC in children.
METHODS AND RESULTS: Twenty-three cases of DC following colostomy for Hirschsprung's disease in young children were analysed. The distinguishing features included prominent follicular lymphoid hyperplasia (100%), chronic mucosal inflammation (100%), accompanied by a variable degree of acute inflammation (78%) and Paneth cell metaplasia (26%). Less frequent histological findings were as follows: mild goblet cell depletion (22%), foci of cryptitis (13%), crypt abscesses (13%) and mild architectural distortion (22%). A previously unrecognized feature was the presence of mucosal aggregates of eosinophils, found in 43% of cases. A striking similarity between the normal appearance of the vermiform appendix and pathological features in DC was noted and the possible relationship between the two is discussed.
CONCLUSIONS: Histological features of DC in children are very similar to those described in adults. They should help to distinguish it from ulcerative colitis and Hirschsprung's-associated enterocolitis in order to prevent inappropriate therapy and follow-up. There are many similarities between DC and the normal appendix vermiformis.
DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES Crohn's disease
PROGNOSIS AND TREATMENT CHARACTERIZATION PROGNOSTIC FACTORS Diversion colitis in patients scheduled for colostomy closure.
Orsay CP, Kim DO, Pearl RK, Abcarian H.
Section of Colon and Rectal Surgery, Cook County Hospital, Chicago, Illinois 60612.
Dis Colon Rectum 1993 Apr;36(4):366-7 Abstract quote
Despite recent work, diversion colitis remains poorly defined.
Thirty-four patients, scheduled for colostomy closure, were prospectively evaluated with flexible sigmoidoscopy for diversion colitis. Biopsies and cultures were obtained if colitis was identified at endoscopy. All biopsy materials and cultures were consistent with inflammation only. The vast majority of patients were in good general health, and their colostomies were constructed as the result of trauma. Eight patients (24 percent) had normal-appearing colons at an average of 16.6 weeks following diversion. Twenty-six patients (76 percent) demonstrated mild to severe colitis at an average of 29.9 weeks following diversion. Three complications occurred in 22 patients after colostomy closure: two wound infections in patients with colitis and one in a patient with a normal colon.
We conclude that diversion colitis in an otherwise individual constitutes no increased risk of infection following colostomy closure.
Diversion colitis: a trigger for ulcerative colitis in the in-stream colon?
Lim AG, Langmead FL, Feakins RM, Rampton DS.
Department of Gastroenterology, Royal London Hospital, Whitechapel, London, UK
Gut 1999 Feb;44(2):279-82 Abstract quote
The aetiology of ulcerative colitis is unknown. Two patients without pre-existing inflammatory bowel disease in whom end colostomy for faecal incontinence was complicated by diversion colitis in the defunctioned rectosigmoid colon, are described. In both instances, colitis with the clinical, colonoscopic, and microscopic features of ulcerative colitis developed about a year later in the previously normal in-stream colon proximal to the colostomy.
These cases suggest that diversion colitis may be a risk factor for ulcerative colitis in predisposed individuals and that ulcerative colitis can be triggered by anatomically discontinuous inflammation elsewhere in the large intestine.
TREATMENT Treatment of diversion colitis with short-chain-fatty acid irrigation.
Harig JM, Soergel KH, Komorowski RA, Wood CM.
Department of Medicine, Medical College of Wisconsin, Milwaukee.
N Engl J Med 1989 Jan 5;320(1):23-8 Abstract quote
A condition known as diversion colitis frequently develops in segments of the colorectum after surgical diversion of the fecal stream; it persists indefinitely unless the excluded segment is reanastomosed. The disease is characterized by bleeding from inflamed colonic mucosa that mimics the bleeding of idiopathic inflammatory bowel disease, and it may culminate in stricture formation. We hypothesized that this condition is caused by the absence of luminal short-chain fatty acids, the preferred metabolic substrates of colonic epithelium.
We studied four patients with diversion colitis, none of whom had evidence of Crohn's, idiopathic ulcerative, or infectious colitis. The excluded segment of the rectosigmoid contained negligible concentrations of short-chain fatty acids. When D-glucose was instilled, it did not undergo appreciable anaerobic fermentation. Instillation of a solution containing short-chain fatty acids twice daily resulted in the disappearance of symptoms and the inflammatory changes observed at endoscopy, over a period of four to six weeks. Remission has been maintained for up to 14 months (in one patient) by instillation daily to twice weekly. Administering enemas containing isotonic saline, or omitting treatment for periods of two to four weeks during the regimen, by contrast, did not produce any improvement or rapid relapse of the colitis. Histologic observation revealed a distinctive type of mucosal inflammation that resolved more slowly and less completely than the gross appearance of the inflamed mucosa.
From these preliminary studies we infer that diversion colitis may represent an inflammatory state resulting from a nutritional deficiency in the lumen of the colonic epithelium, which is effectively treated by local application of short-chain fatty acids, the missing nutrients.
Treatment of diversion colitis by short-chain fatty acids. Prospective and double-blind study.
Guillemot F, Colombel JF, Neut C, Verplanck N, Lecomte M, Romond C, Paris JC, Cortot A.
Clinique des Maladies de l'Appareil Digestif, Hopital Claude Huriez, Lille, France.
Dis Colon Rectum 1991 Oct;34(10):861-4 Abstract quote
Diminished production of short-chain fatty acids (SCFA) by altered flora has been suggested in the pathogenesis of diversion colitis (DC).
We evaluated prospectively the effectiveness of SCFA irrigation in 13 patients with excluded colon (eight males, five females; mean age, 48 years). The causes of diversion were inflammatory bowel disease (n = 4), colonic cancer (n = 2), sigmoid diverticulitis with perforation (n = 3), ischiorectal abscess (n = 2), and miscellaneous (n = 2). Patients were given, twice a day for 14 days in a double-blind manner, a 60-ml enema containing either SCFA (acetate: 60 mmol/liter; propionate: 30 mmol/liter; and N-butyrate: 40 mmol/liter) (Group 1; n = 7) or isotonic NaCl (Group 2; n = 6). Endoscopy with biopsies was performed before starting the trial (D1) and 14 days later (D14). On D1 all patients had endoscopic and histologic findings suggestive of DC. No endoscopic or histologic changes were observed on D14 in either group.
We conclude that endoscopic and histologic lesions of DC were not improved by SCFA irrigation during the 14 days.
A case of diversion colitis treated with 5-aminosalicylic acid enemas.
Tripodi J, Gorcey S, Burakoff R.
Division of Gastroenterology, Winthrop University Hospital, Mineola, New York.
Am J Gastroenterol 1992 May;87(5):645-7 Abstract quote
An 85-yr-old female presented with diversion colitis after surgery with a resultant colostomy and excluded rectal segment. Treatment with 5-aminosalicylic acid (Rowasa) enemas resulted in both endoscopic and histological resolution.
This is the first case of diversion colitis treated with 5-aminosalicylic acid enemas.
Rosai J. Ackerman's Surgical Pathology. Eight Edition. Mosby 1996.
Sternberg S. Diagnostic Surgical Pathology. Third Edition. Lipincott Williams and Wilkins 1999.
Last Updated 11/30/2001
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