Abstract
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, andC. 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 out 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. The vast majority of patients remain asymptomatic. There is no need for distal biopsies or other tests when this condition is found in asymptomatic patients. Furthermore, except in patients who have an indication for neoplastic screening, there is no need to examine the proximal “in continuity” colon in asymptomatic patients. Colostomy closure need not be delayed in these patients. However, those patients with significant symptoms or a history of colitis or diarrhea should undergo a complete proximal and distal colonic evaluation prior to stomal closure. Biopsies appear to have little or no role in establishing the diagnosis of diversion colitis.
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Bories C, Miazza B, Galian A, et al (1986) Idiopathic chronic watery diarrhea from excluded rectosigmoid with goblet cell hyperplasia cures by restoration of large bowel continuity. Dig Dis Sci 31: 769–772
Bosshardt RT, Abel MD (1984) Proctitis following fecal diversion. Dis Colon Rectum 27: 605–760
Bugaut M (1987) Occurrence, absorbtion and metabolism of short chain fatty acids in the digestive tract of mammals. Comp Biochem Physiol 86B: 439–472
Cummings JH, Pomare EW, Branch WJ, et al (1987) Short chain fatty acids in human large intestine, portal, hepatic and venous blood. Gut 28: 1221–1227
Glotzer DJ, Glick ME, Goldman H (1981) Proctitis and colitis following diversion of the fecal stream. Gastroenterology 80: 438–441
Haas PA, Fox TA, Szilagy EJ (1990) Endoscopic examination of the colon and rectum distal to a colostomy. Am J Gastroenterol 85: 850–854
Harig JM, Soergel KH, Komorowski RA, Wood CM (1989) Treatment of diversion colitis with short-chain-fatty acid irrigation. N Engl J Med 320: 23–28
Komorowski RA (1990) Histologic spectrum of diversion colitis. Am J Surg Path 14: 548–554
Korelitz BI, Cheskin LH, Sohn N, Sommers SC (1984) Proctitis after fecal diversion in Crohn’s disease and its elimination with reanastomosis: implications and surgical management. Gastroenterology 87: 710–713
Lechner RL, Frank F, Jantsch H, et al (1990) Lymphoid follicular hyperplasia in excluded colonic segments: a radiologic sign of diversion colitis. Radiology 176: 135–136
Lusk LB, Reichen J, Levine JS (1984) Apthous ulceration in diversion colitis: clinical implications. Gastroenterol 87: 1171–1173
Ma CK, Gottlieb C, Haas PA (1990) Diversion colitis: a clinicopathologic study of 21 cases. Hum Pathol 21: 429–436
Murray FE, O’Brien MJ, Birkett DH, Kemmedy SM, LaMont JS (1987) Diversion colitis: pathologic findings in a resected Sigmoid colon and rectum. Gastroenterology 93: 1404–1408
Ona FV, Boger JN (1985) Rectal bleeding due to diversion colitis. Am J Gastroenterol 80: 40–41
Ranchod M, Kewin KJ, Dorfman RF (1978) Lymphoid hyperplasia of the gastrointestinal tract: a study of 26 cases and review of the literature. Am J Surg Pathol 12: 383–398
Roediger WE (1980) Role of anaerobic bacteria in the metabolic welfare of the colonic mucosa in man. Gut 21: 793–798
Roediger WEW, Rae DA (1982) Trophic effect of short chain fatty acids on mucosal handling of ions by the defunctionalized colon. Br J Surg 69: 23–25
Roediger WEW (1990) The starved colon — diminished mucosal nutrition, diminished absorbtion, and colitis. Dis Colon Rectum 33: 858–862
Scott RL, Pinstein ML (1984) Diversion colitis demonstrated by double contrast barium enema. Am J Radiol 143: 767–768
Stein DT, Paldi JH, Goodwin DA (1983) In-111 leukocyte scan in “diversion colitis”. Clin Nucl Med 7: 1–2
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Whelan, R.L., Abramson, D., Kim, D.S. et al. Diversion colitis. Surg Endosc 8, 19–24 (1994). https://doi.org/10.1007/BF02909487
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DOI: https://doi.org/10.1007/BF02909487