Diversion Colitis

Abstract

Diversion colitis (DC) involves nonspecific colonic inflammation following surgical diversion of the fecal stream away from the upstream colon. Although most patients are asymptomatic, endoscopic evidence of DC can be found in the majority of patients after diversion. Clinical symptoms include abdominal pain or discomfort, tenemus, and rectal bleeding and discharge. Endoscopically, mucosal edema, erythema, friability, erosions or ulcerations, exudates, and mucosal nodularity can be observed. Histopathologically, diffuse inflammation, crypt architectural abnormalities, crypt abscesses or atrophy, and lymphoid follicular hyperplasia can be seen. The colonic inflammation is generally mild and limited to the mucosa. The pathogenesis of DC is unclear. Restoring the fecal stream to the affected colon segment reverses DC. Conservative treatment options, such as enemas, may offer symptomatic improvement. In this video presentation, the endoscopic and pathological findings associated with DC are described. This article is part of an expert video encyclopedia.