Diversion procto-colitis: response to treatment with short-chain fatty acids.
OBJECTIVE
Diversion procto-colitis (DPC) results from a deficiency of luminal short-chain fatty acids (SCFAs). Endoscopic and histopathologic features of the disorder are almost universally present in defunctioned bowel, but symptomatic DPC is less common.


METHODS
Five children with symptomatic DPC underwent endoscopy and rectosigmoid biopsies. An endoscopic index (EI) was used to quantify disease severity. An SCFA mixture was administered into the defunctioned bowel.


RESULTS
A good clinical response and improvement in the endoscopic index occurred in all children. Undiversion or rectal excision was carried out in 4 and was curative in each case. One child is awaiting a redo pull through.


CONCLUSIONS
DPC should be considered in children with a defunctioned colon presenting with evidence of colitis. Histopathology provides supportive evidence and SCFAs may provide effective relief of symptoms. Stoma reversal or rectal excision is curative.
Kiely
E M
EM
Department of Surgery, Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3JH, England.
Ajayi
N A
NA
Wheeler
R A
RA
Malone
M
M
D002648:Child; D002675:Child, Preschool; D003125:Colostomy / Q000009:adverse effects*; D005232:Fatty Acids, Volatile / Q000627:therapeutic use*; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D011350:Proctocolitis / Q000209:etiology / Q000473:pathology / Q000628:therapy*
D005232:Fatty Acids, Volatile