A severe case of diversion colitis with large ulcerations

Diversion colitis is an inflammatory condition that develops in the excluded segment of colon after surgical diversion. Inflammatory changes include aphthous-type ulcerations, crypt abscesses, and mucosal friability. These features may be seen in other inflammatory diseases of the colon, making diagnosis difficult. Even though symptoms such as cramping pain, bleeding, and mucous discharge have been described with diversion colitis, most cases are asymptomatic. In this article we report a patient who presented with sepsis secondary to severe diversion colitis with several large (2-4 cm in diameter), deep ulcerations and air in the colonic wall, requiring colectomy.