Diversion Colitis

Management of the patient with diversion colitis is dependent upon both patient and disease-related factors. Patients in whom diversion is not permanent, who desire stoma closure, and who have an acceptable surgical risk should undergo re-establishment of intestinal continuity. Asymptomatic, high-risk surgical candidates need only undergo periodic, regular endoscopic surveillance of both the functional and nonfunctional large bowel according to currently accepted screening guidelines. Most symptomatic patients in whom the diversion is permanent can be treated successfully with steroid enemas, 5-aminosalicylic acid enemas or suppositories, or short-chain fatty acid enemas. If diversion is permanent, medical treatment is unsuccessful, and symptoms persist, acceptable surgical candidates should undergo resection of the excluded bowel.