Original researchPathophysiology, clinical presentation and management of diversion colitis: A review of current literature

- Diversion colitis is a non-specific inflammation of a de-functioned segment of intestine after diversion of the faecal stream.
- Epidemiological studies are limited; in-spite of this an incidence rate of 100% has been shown in some studies.
- Up to 33% of patients with a stoma may have symptomatic diversion colitis.
- The absence of any characteristic pathognomonic features makes it difficult to diagnose and appearances can be similar to IBD.
- Severely symptomatic patients will benefit form re-anastamosis of the diverted faecal stream.

Introduction: Diversion colitis is a non-specific inflammation of a de-functioned segment of intestine after diversion of the faecal stream. Aim: The aim of this study was to review the current level of knowledge about diversion colitis. Methods: A literature search of relevant literature in the English language was carried out on PUBMED, MEDLINE and EMBASE. The following keywords were used: diversion colitis; disuse colitis; proctitis; colonic bacterial flora; stoma; de-functioned colon; faecal diversion; short chain fatty acids and lymphoid follicular hyperplasia. Results: In total 35 articles met the inclusion criteria. 22 were case series, 9 were case reports, 2 were retrospective analysis and 2 were prospective randomized controlled studies. Diversion colitis is invariably present in all diverted segments of the colon. It is usually asymptomatic but can present with tenesmus, rectal discharge, bleeding per rectum and abdominal pain. Major macroscopic changes include mucosal nodularity, erythema and friability. Microscopic features are predominantly those of lymphoid follicular hyperplasia, apthous ulceration and chronic inflammatory changes, mostly limited to sub mucosa. Treatment modalities include surveillance for asymptomatic patients, restoration of bowel continuity for severely symptomatic cases and the use of short chain fatty acid (SCFA) enemas in selected cases. Conclusion: The clinical presentation of diversion colitis varies significantly. In symptomatic patients short chain fatty acid enema may help. Further prospective studies are required for evaluation.