BackgroundDiversion colitis (DC) seems to be common in stoma patients, and the restoration of the continuity of the digestive tract is crucial for relief from the inflammatory process. No prospective studies of the late effects of DC on the lower gastrointestinal (GI) tract mucosa and the clinical condition of patients have been reported.MethodsData from 23 patients who underwent stoma creation were analysed during the reversal period (A) and at an average of 3 months (B1) and 5.6 years (B2) after restoration of GI tract continuity. Every monitoring visit included endoscopy, histology and assessment of the clinical condition of patients.ResultsShortly after GI tract restoration (B1), a significant decrease in inflammation was observed. The Ki67 positivity percentage increased, but this was not significant. At an average of 5.6 years after restoration (group B2), the clinical symptoms were mild. More patients presented with endoscopically detected inflammation of the mucosa, but its severity was not significantly higher than that at 3 months after reversal. Histological inflammation was more common, and its severity was significantly higher than that shortly after reversal but similar to that before reversal. The Ki67 positivity percentage decreased at the last examination (B2).ConclusionsThe results of this study show a complex recurrence of histological inflammation several years after GI tract restoration but without clinical and endoscopic inflammation and with good clinical condition. DC can potentially have a late influence on the rectal mucosa, even after stoma closure.

The aim of this study was to present current knowledge about a nospecific inflammation of mucosa within segments of colon excluded from normal bowel passage called as a "diversion colitis" (DC) and to try to determine the role of factors which might modify the clinical course of DC. We also unswered the question; how to treat DC: conservatively or surgically? Our own experience with DC concerns 145 patents (which is most numerous and well exactly examined series presented in literature). In the group of patients studied, clinical signs of DC were present in over 70% of patients (early signs were low abdominal pain and tenesmus, while anal oozing appeared later). Predominating endoscopic features of DC in the group of patients studied were: a. blurring of vascular pattern (in app. 90% of patients); b. contact bleeding (in app. 80% of patients); c. mucosal oedema (in app. 60% of patients). Results of own observations and literature data indicate, that morphologic alterations in the segment of bowel excluded from normal passage are probably vasogenic consisting in atrophy and inflammation of the allergic type (this would confirm the theory about vascular etiology of DC). In our material, we have not noticed any trend toward hyperproliferation or dysplasia in the excluded segment of colon, supporting the thesis that these disturbances are largely reversible. Clinical pathology of DC does not depend on age, sex, cause and type of surgical procedure performed, mode of surgery or concomitant diseases. Authors suggested an alternative algorithm of diagnostic work-up in patients suspected of DC, and proposed that patients with a segment of bowel excluded from normal passage be subdivided into three groups: 1. Patients with no clinical, endoscopic nor morphologic signs of DC. 2. Patients with moderate signs of DC. 3. Patients with severe signs of DC. Patients in the group 1 should remain under continuous specialised supervision, because they are at risk of developing DC, while patients in the groups 2 and 3 should undergo surgical restoration of bowel continuity. This applies particularly to group 3, where indications for surgery do not stem from risk of hyperproliferation, dysplasia or malignant transformation, but from that of a massive inflammation, which may constitute a danger for patientis health and even life. Authors also underline that DC can be treated conservatively but the best and most successful and remained method of treatment of DC is the operation of decolostomy, which means restoration continuity of digestive tract.

The most common occurred long-term stoma complication is parastomal hernia (PH). The incidence of this complication reaches 50% and, according to Goligher 1 , the parastomal hernia is an inevitable consequence in a certain percentage of all cases of stoma formation. The factors that may affect the incidence of parastomal hernia include the site of stoma, particularly its position relative to the rectus muscle of abdomen, preoperative mapping out of the stoma site, stoma diameter, intraperitoneal or extraperitoneal bringing out of the intestine and its fixation to fascia, closing of the area around the stoma opening, the mode of operation -planned or emergency, and finally the kind of stoma -ileostomy, colostomy, end stoma and loop stoma. None of these factors, however, has been identified to have the key importance in parastomal hernia formation. It seems that the only factor that significantly increases the incidence of parastomal hernia is the length of post-operative period.