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Diversion colitis. A prospective study

R L Whelan1, D Abramson, D S Kim

  • 1Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032.

Surgical Endoscopy
|January 1, 1994
PubMed
Summary
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Diversion colitis affects nearly all patients with fecal diversion, causing mild to moderate inflammation. This condition resolves completely after stomal closure.

Area of Science:

  • Gastroenterology
  • Colorectal Surgery

Background:

  • Fecal diversion is a surgical procedure that reroutes the colon.
  • Diversion colitis is a poorly understood condition affecting the diverted bowel.

Purpose of the Study:

  • To determine the incidence of diversion colitis.
  • To characterize the endoscopic and histologic features of diversion colitis.
  • To evaluate the resolution of diversion colitis after stomal closure.

Main Methods:

  • Prospective study of 53 patients who underwent fecal diversion.
  • Endoscopic evaluation of the diverted large bowel.
  • Histologic analysis of biopsies from diverted and non-diverted segments.
  • Bacterial, ova, parasite, and C. Diff. toxin analysis of stool and rectal washings.

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Main Results:

  • Diversion colitis was found in 91% of patients.
  • Mild (52%) and moderate (44%) colitis were most common.
  • Endoscopic findings included erythema and mucosal nodularity.
  • Histologic findings showed mild chronic inflammation and crypt changes.
  • No colitis was observed in the "in continuity" colon.
  • Symptoms were reported by only 6% of patients.
  • Complete resolution occurred in all patients after stomal closure.

Conclusions:

  • Diversion colitis is a highly prevalent condition following fecal diversion.
  • The condition is generally mild to moderate and resolves with stomal closure.
  • Endoscopic and histologic findings are characteristic but not specific.