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

Kabir, S.I.; Kabir, Syed Adnan; Richards, R. L.; Ahmed, Jamil; MacFie, John

doi:10.1016/j.ijsu.2014.08.350

Cited by 60 publications

(46 citation statements)

References 37 publications

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“…The incidence has been described to vary between 50% and 91% [ 3 – 5 ]. Although the majority of patients do not suffer from clinical symptoms, up to 40% of affected patients report clinical symptoms including mucous discharge, abdominal pain, bleeding, and tenesmus [ 1 , 5 , 23 ]. Severe clinical courses have been described sporadically [ 3 , 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Severe clinical courses have been described sporadically [ 3 , 24 , 25 ]. However, symptoms can persist even after reversal of fecal diversion and negatively affect the quality of life [ 5 , 23 , 26 ]. In patients where reestablishment of intestinal continuity is not feasible, surgical resection of the dysfunctioned bowel segment may be necessary when medical anti-inflammatory treatment fails.…”

Section: Discussionmentioning

confidence: 99%

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Deviation of the Fecal Stream in Colonic Bowel Segments Results in Increased Numbers of Isolated Lymphoid Follicles in the Submucosal Compartment in a Novel Murine Model of Diversion Colitis

Kleinwort

Döring

Hackbarth

et al. 2017

BioMed Research International

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Introduction Diversion colitis is a significant health problem due to its high incidence in patients with diverting enterostomy. This mucosal inflammation presents characteristic histopathological features allowing for the differentiation of this entity from other inflammatory bowel diseases. The pathophysiology of this disease remains ill-defined, in part due to the lack of appropriate animal models. The present study was performed in order to develop and characterize a murine model of diversion colitis. Methods A diverting loop colostomy was performed in C57BL/6 mice either in the ascending colon or in the transverse colon. Animals were assessed for clinical and histopathological parameters during short-term and long-term survival. Results Animals with a colostomy in the transverse colon showed a good long-term survival and developed a mild colitis in the bypassed bowel closely resembling the human pathology on a histopathological level. Conclusion This model is a promising tool to further elucidate the pathomechanism leading to impaired mucosal homeostasis in bypassed colonic segments. Moreover, the establishment of the model in the C57BL/6 background allows the combination of this colitis model with various transgenic mouse strains to investigate the effect of locally deregulated mucosal immunity on systemic immune homeostasis and to develop specific therapeutic strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Deviation of the Fecal Stream in Colonic Bowel Segments Results in Increased Numbers of Isolated Lymphoid Follicles in the Submucosal Compartment in a Novel Murine Model of Diversion Colitis

Kleinwort

Döring

Hackbarth

et al. 2017

BioMed Research International

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“…L-Glutamine is a fuel source for the epithelial cells of colon [ 3 , 4 , 7 ]. It is an essential precursor for nucleic acid bio-synthesis and is therefore essential for proliferation of cells with rapid turnover such as the intestinal mucosa.…”

Section: Discussionmentioning

confidence: 99%

“…SCFA are produced by fermentation of fibers. Thus fibers act as a substrate to provide the colonocytes a fuel source in the form of SCFA [ 1 , 3 ]. The present study has found that there was no significant difference in epithelial cell height and mucosal thickness of Group III that received Psyllium.…”

Section: Discussionmentioning

confidence: 99%

Prevention of Histological Changes after Colonic Diversion in Rats: An Experimental Study

2017

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AIM :To determine the beneficial effects of Glutamine, Psyllium, Short Chain Fatty Acids (SCFA), and Maharishi Amrit Kalash (MAK), in preventing the histological changes after diversion colostomy.MATERIAL AND METHODS :After ethical clearance, male wistar rats (n=40) underwent diversion colostomy. Rats were divided into five groups of 8 rats each. Each group was given, after diversion colostomy, per rectally, one of the five agents being tested as an enema (3 ml/kg/day). Group I: Normal saline. Group II: Glutamine Group III: Psyllium, Group IV: MAK. Group V: Short chain fatty acid. The rats were euthanised 45 days after performing diversion colostomy. Morphometrical analysis of defunctionalised colon was done. Statistical analysis was done using SSPS statistical analysis software.RESULTS :On comparison with Group I epithelial cell height and mucosal thickness was significantly higher in Group II. Muscularis externae thickness was significantly higher in Group III on comparison with Group I. Group V had least inflammatory changes.CONCLUSIONS :Atrophic and inflammatory changes in the diverted colon can be prevented by per rectal administration of Glutamine, Psyllium and Short chain fatty acids.

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“…This is important to protect the gut barrier, reduce bacterial translocation, and even decrease the morbidity and mortality by reducing the septic complications. PDLI can manage the diversion proctocolitis by antegrade succus entericus reinfusion, which may also prevent the colonic complications such as diarrhea, obstruction, missing colon fistula and stenosis after performing closure of the stoma [38,39]. PDLI could decrease the rate of reoperation, the hospitalization time and cost of hospitalization.…”

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confidence: 99%

Open necrosectomy combined with continuous positive drainage and prophylactic diverting loop ileostomy for late infected pancreatic necrosis: a retrospective cohort study

Niu

Huang

et al. 2020

BMC Gastroenterol

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Background: To evaluate an innovative open necrosectomy strategy with continuous positive drainage and prophylactic diverting loop ileostomy for the management of late infected pancreatic necrosis (LIPN). Methods: Consecutive patients were divided into open necrosectomy (ON) group (n = 23), open necrosectomy with colonic segment resection (ON+CSR) group (n = 8) and open necrosectomy with prophylactic diverting loop ileostomy (ON+PDLI) group (n = 11). Continuous positive drainage (CPD) via double-lumen irrigation-suction tube (DLIST) was performed in ON+PDLI group. The primary endpoints were duration of organ failure after surgery, postoperative complication, the rate of re-surgery and mortality. The secondary endpoints were duration of hospitalization, cost, time interval between open surgery and total enteral nutrition (TEN). Results: The recovery time of organ function in ON+PDLI group was shorter than that in other two groups. Colonic complications occurred in 13 patients (56.5%) in the ON group and 3 patients (27.3%) in the ON+PDLI group (p = 0.11). The length of stay in the ON+PDLI group was shorter than the ON group (p = 0.001). The hospitalization cost in the ON+PDLI group was less than the ON group (p = 0.0052). Conclusion: ON+PDLI can avoid the intestinal dysfunction, re-ileostomy, the resection of innocent colon and reduce the intraoperative trauma. Despite being of colonic complications before or during operation, CPD + PDLI may show superior effectiveness, safety, and convenience in LIPN.

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

Abstract: 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.

Cited by 60 publications

References 37 publications

Deviation of the Fecal Stream in Colonic Bowel Segments Results in Increased Numbers of Isolated Lymphoid Follicles in the Submucosal Compartment in a Novel Murine Model of Diversion Colitis

Deviation of the Fecal Stream in Colonic Bowel Segments Results in Increased Numbers of Isolated Lymphoid Follicles in the Submucosal Compartment in a Novel Murine Model of Diversion Colitis

Prevention of Histological Changes after Colonic Diversion in Rats: An Experimental Study

Open necrosectomy combined with continuous positive drainage and prophylactic diverting loop ileostomy for late infected pancreatic necrosis: a retrospective cohort study

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