Diversion colitis

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Diversion colitis is an inflammatory condition of the colon that occurs in patients who have undergone surgical diversion of the fecal stream. This condition is commonly seen in patients with ileostomy or colostomy.

Pathophysiology

The pathophysiology of diversion colitis is primarily related to the lack of short-chain fatty acids (SCFAs) in the diverted segment of the colon. SCFAs, which are produced by the bacterial fermentation of dietary fibers, play a crucial role in maintaining colonic health. The absence of these SCFAs leads to mucosal atrophy, inflammation, and the development of colitis.

Clinical Presentation

Patients with diversion colitis may present with a variety of symptoms, including:

• Abdominal pain
• Rectal bleeding
• Mucus discharge
• Tenesmus

Diagnosis

The diagnosis of diversion colitis is typically made based on clinical history, endoscopic findings, and histological examination. Endoscopy may reveal erythema, friability, and ulceration of the colonic mucosa. Histologically, the colonic mucosa shows features of chronic inflammation, including lymphocytic infiltration and crypt abscesses.

Treatment

The primary treatment for diversion colitis involves the restoration of the fecal stream to the affected segment of the colon, which can be achieved through surgical re-anastomosis. In cases where re-anastomosis is not feasible, other treatments may include:

• Topical application of SCFAs
• Anti-inflammatory medications
• Probiotics

Prognosis

The prognosis for patients with diversion colitis is generally good, especially if the fecal stream can be restored. In cases where re-anastomosis is not possible, long-term management with medical therapy can help control symptoms and prevent complications.

See also

• Colitis
• Ileostomy
• Colostomy
• Inflammatory bowel disease