Abstract
Introduction: Diversion colitis (DC) is an uncommon entity and its pathogenesis is not clear. We report a case of DC and perform a qualitative meta-analysis(QMA) on 636 cases of DC. Methods: A 22-year-old man with Crohn’s disease developed crampy lower abdominal pain. He had an ileaostomy with Hartmann’s pouch. His Hb 11.8, hcrit 36.8. Flex Sig to 20 cm showed erythema, erosions, friability. Bx confirmed DC. PubMed search without time or language barrier was done. Additional papers were manually added. To facilitate QMA, summary sheets of all the papers were created. QMA was performed using the Methods of Qualitative Reserach viz Diagramming,Theme Repetition Without Serious Contradiction, Theme Saturation, and Investigator Reflexivity (Eval Rev 1985;9:627-643, The Lancet 2001;358:483-488. Ann Fam Med 2008;6:331-339). Quantitative data can be used for QMA. Results: Search yielded 636 cases of DC. Gender information available in 575/636 (90.4%). Men 341/575 (59.3%); women 234/575 (40.7%). Mean age 45.0 (range16-86) years, mean incidence of DC 70% (range 50-90), interval after colostomy 1 month to 22 years. Clin features crampy abdominal pain, bloodymucoid anal discharge, perineal ulceration, tenesemus. Some are asymptomatic. Endo features erythema,contact bleeding, erosions, aphthousulcers, mucosaledemam, mucus plugs, granularity polyps, cancer. Histology acute, chronic inflammation, lymphoid hyperplasia (characteristic) ulceration, changes in crypts, mucin depletion, paneth cell metaplasia, changes due to ishemia. Mechanism of injury deficiency of shortchain fatty acids (SCFA), abnormal bacterial flora, oxidative damage, increased nitrate reducing bacteria, decrease E- Cadherin, and ischemic damage. DC also seen in sigmoid neo-vagina. Mangement of DC enemata of SCFA, steroids, 5-ASA, heparin, n-acetylcysteine, fibers, surgical reanastomosis, or resection. Conclusion: Information on 636 cases of DC with QMA is presented. The clinical, endoscopic, and histologic features are presented as various possible therapeutic interventions. Possible pathogenetic mechanisms are discussed.
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