Collagenous colitis and fecal stream diversion

The cause of collagenous colitis is unknown. Data on treatment are sparse, and surgical therapy has not been reported. This study reports results of surgical therapy for collagenous colitis.

Nine women with unresponsive collagenous colitis underwent surgery. An ileostomy was performed as the first procedure in 8 patients, and a sigmoidostomy using the Hartmann procedure was performed in 1 patient.

Preoperatively, all patients had severe diarrhea, and the median thickness of the subepithelial collagenous layer was 20 microns (range, 10-40 microns). Postoperatively, diarrhea ceased in all patients, and the collagen layer was reduced to 2 microns (range, 0-10 microns). Clinical symptoms and the abnormal collagen layer recurred after restoration of intestinal continuity. After the Hartmann procedure, the collagen layer remained abnormally thickened up to 30 microns in the proximal colon but was normalized in the excluded rectosigmoid colon. One year later, the sigmoidostomy was replaced by a split ileostomy; at follow-up, the collagen layer was normal in the whole colon.

Fecal stream diversion induced clinical and histopathologic remission in collagenous colitis. After closure of the ostomy, clinical symptoms and the abnormal collagen layer recurred. The findings strongly indicate that a noxious luminal factor is of pathogenetic importance. In older patients with medically resistant disease, a split ileostomy may be the therapeutic procedure of choice.