title: Pathophysiology, clinical presentation and management of diversion colitis: a review of current literature.
abstract: BACKGROUND
  Diversion colitis is a non-specific inflammation of a de-functioned segment of intestine after diversion of the faecal stream.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Wexham Park Hospital, Slough SL2 4HL, United Kingdom. Electronic address: irfankabir@hotmail.com.
authors.forename: S I
authors.initials: SI
authors.lastname: Kabir
authors.affiliation: Department of Surgery, Lincoln County Hospital, Lincoln LN2 5QY, United Kingdom.
authors.forename: S A
authors.initials: SA
authors.lastname: Kabir
authors.affiliation: Department of Surgery, Scarborough District Hospital, Scarborough YO12 6QL, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Richards
authors.affiliation: Department of Surgery, Scarborough District Hospital, Scarborough YO12 6QL, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Ahmed
authors.affiliation: Department of Surgery, Scarborough District Hospital, Scarborough YO12 6QL, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: MacFie
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D005871:Castleman Disease / Q000209:etiology; D003092:Colitis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004733:Enema; D004890:Erythema / Q000209:etiology; D005232:Fatty Acids, Volatile / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007249:Inflammation / Q000209:etiology; D007413:Intestinal Mucosa / Q000473:pathology; D011183:Postoperative Complications; D012007:Rectum / Q000601:surgery
chemical_list: D005232:Fatty Acids, Volatile
keywords: Disuse colitis; Diversion colitis; Lymphoid follicular hyperplasia; Short chain fatty acid