Diversion Colitis-A case report-

Abstract

Diversion colitis is an inflammatory process that occurs in the excluded segments of the colorectum after surgical diversion of fecal stream, such as ileostomy or colostomy. The incidence of diversion colitis is reported as high as 100%, when observed prospectively, and the symptoms occur typically from 3 to 36 months after diverting surgery. The majority of patients are usually asymptomatic, but up to 50% of patients complains of abdominal pain, mucous discharge, and sometimes bloody diarrhea. Endoscopic appearance of diversion colitis has a broad spectrum of possible appearances from being normal to showing signs of severe inflammation, such as mucosal erythema, edema, friability, granularity or nodularity, aphthous ulceration, bleeding or strictures. The histopathologic changes are diffuse nonspecific acute and chronic inflammation, crypt distortion, crypt abscess, lymphoid follicular hyperplasia in excluded segments of colorectum. The choice of treatment is reanastomosis. After reanastomosis, most patients have symptomatic improvement and the excluded segments of colorectum will be normalized endoscopically and histologically. When the underlying condition does not allow reanastomosis, the symptomatic treatment such as mixed short-chain fatty acid solution enemaor instillation should be helpful. We experienced a case of diversion colitis 18 months after low anterior resection and transverse loop colostomy due to rectal cancer.