Table of ContentsView AllTable of ContentsTypes of Ostomy SurgeryCauseRisk FactorsSymptomsComplicationsDiagnosisTreatments
Table of ContentsView All
View All
Table of Contents
Types of Ostomy Surgery
Cause
Risk Factors
Symptoms
Complications
Diagnosis
Treatments
Diversion colitis is a common inflammatory condition of the large intestine (colon) that sometimes occurs aftercolostomyorileostomysurgery. It can occur in anyone who has ostomy surgery that spares a section of the large intestine, but it happens more frequently in people who also haveinflammatory bowel disease (IBD).
Diversion colitis is not the same as ulcerative colitis, because it is not an immune-mediated condition nor a progressive disease.
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Ostomy surgery may be performed to treatulcerative colitis,Crohn’s disease, cancer, or a variety of other conditions. It’s also known as fecal diversion because it diverts stool away from a damaged or healing section of the digestive tract, such as the small intestine or colon. Studies estimate that between 13% and 37% of people with IBD have a fecal diversion.
This surgery creates an opening, orstoma, through the bowel for stool to pass into a bag (ostomy pouch) attached outside the abdomen. In some cases, in addition to removal of part of the intestines, the anus and rectum may also be removed.
There are two common types of ostomy surgery.
Ileostomy
An opening is made in the last section of the small intestine, called the ileum. An end ileostomy procedure separates the ileum from the colon and it’s brought through the abdomen wall to form a stoma. A loop ileostomy pulls a section of the small intestine through a small incision before being opened up and attached to the skin to create a stoma.
End ileostomies are usually permanent while loop ileostomies are often temporary (lasting three to six months) and can be reversed later.
Colostomy
A colostomy is similar to an ileostomy, but in a colostomy, a piece of the large intestine is brought through the abdomen wall to create a stoma. This procedure can be done as an end colostomy or a loop colostomy; like an ileostomy. In some cases where all or part of the large intestine is removed, a part of the small intestine is brought through to the outside of the abdomen to create a stoma.
It’s not known exactly what causes diversion colitis. However, it’s thought that because the ostomy diverts undigested food, it changes the gut microbiome.
Your gut microbiome contains trillions of bacteria important for proper digestion. They work to digest fiber and carbohydrates to make short-chain fatty acids (SCFAs). These acids help to keep the colon lining healthy. The diverted part of the colon has lower levels of SCFAs to maintain the lining, leading to inflammation.
It’s unclear how many people who have diversion surgeries develop diversion colitis. However, it’s more common in people who have had surgery for IBD.
Not everyone will experience symptoms. However, symptoms may start between three months and three years post-surgery.Although almost everyone who undergoes ostomy surgery has inflammation, only about 30% experience symptoms.
These may include:
It’s important to note that several diversion colitis symptoms can mimic IBD symptoms (abdominal pain, tenesmus, mucus in stool, and bloody diarrhea) and can make it more difficult to diagnose.
Serious complications can occur with diversion colitis.
Some of these may include:
Your healthcare provider will take your medical history and perform a physical exam. Depending on your symptoms, along with your history and exam results, your healthcare provider may request different tests for a diagnosis.
There is no standard treatment for diversion colitis but there are several effective solutions.
Surgery
The most effective and successful treatment is the surgical reversal of the stoma, restoring the continuity of the intestine.
When and how the reversal takes place is individualized for every person.
Enemas
Some people are not candidates for surgical reconnection. Enemas containing short-chain-fatty acids (SCFAs) are used to re-establish the gut microbiome and to help heal the intestinal lining.
One study showed that applying these enemas twice daily resolved symptoms within four to six weeks. Remission of symptoms lasted up to 14 months with daily or twice-a-week use.
Medications
Some medications may help reduce intestinal inflammation and alleviate symptoms, including:
Autologous fecal transplantation
A more recent treatment option is an autologous fecal transplant, which involves using your stool to treat diversion colitis.
A 2021 study found that administering a small amount of a person’s feces to their diverted colon reduced inflammation and alleviated symptoms within two weeks of treatment. There were no adverse events and the treatment is inexpensive.
According to the authors, this is the first study to show significant changes in the intestinal microbiota after autologous fecal microbial transplantation (FMT) in diversion colitis patients.
Summary
Diversion colitis is common but may not cause any symptoms. It usually reverses after the intestine is surgically reconnected. Yet, in some cases, symptoms can be severe and cause complications that may require further treatments.
There is no standard treatment for diversion colitis and more studies are needed to prove the efficacy of non-surgical options. It’s important to consult your healthcare provider to learn which treatment is best suited for you.
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Shen B. UpToDate.Diversion colitis: clinical manifestations and diagnosis.Buono AD, Carvello M, Sachar DB, et al.Diversion proctocolitis and the problem of the forgotten rectum in inflammatory bowel disease: a systemic review.United European Gastroenterol J. 2021;9(10);1157-1167. doi:10.1002/ueg2.12175American Caner Society.What is an ileostomy?NHS Inform.Ileostomy.American Cancer Society.What is a colostomy?Greenson JK, Odze, RD.Inflammatory disorders of the large intestine.Surgical pathology of the GI tract, liver, biliary tract, and pancreas. Second edition.2009.Shen, B. UpToDate.Diversion colitis: clinical manifestations and diagnosis.Greenson JK, Odze RD. Inflammatory disorders of the large intestine. Surgical pathology of the GI tract, liver, biliary tract, and pancreas. (Second edition). 2009:355-394.Tominaga K, Kamimura K, Takahashi K, et al.Diversion colitis and pouchitis: A mini-review.World J Gastroenterol.2018;24(16):1734-1747. doi:10.3748/wjg.v24.i16.1734My Crohns and Colitis Team.What is diversion colitis? 8 things to know.My Crohn’s and Colitis Team.What is diversion colitis? 8 things to know.Szczepkowski M, Banasiewicz T, Kobus A.Diversion colitis: 25 years later: the phenomenon of the disease.Int J Colorectal Dis.2017;32(8):1191-1196. doi:10.1007/s00384-017-2802-zHarig JMH, Soergel KH, Komorowski RA, Wood CM.Treatment of diversion colitis with short-chain fatty acid irrigation.N Engl J Med.1989;320:23-28.Crohn’s and Colitis Canada.Sulfasalazine and 5-AminoSalicylates (5-ASA).Towinga K, Tsuchiya A, Mizusawa T, et al.Utility of autologous fecal microbiota transplantation and elucidation of microbiota in diversion colitis.DEN Open. 2022;2(1):e63. doi:10.1002/deo2.63Additional ReadingKabir SI, Kabir SA, Richards R, Ahmed J, MacFie J. “Pathophysiology, clinical presentation and management of diversion colitis: a review of current literature.” Int J Surg. 2014;12:1088-1092. doi:10.1016/j.ijsu.2014.08.350.Son DN, Choi DJ, Woo SU, et al. “Relationship between diversion colitis and quality of life in rectal cancer.” World J Gastroenterol. 2013;19:542-549. doi:10.3748/wjg.v19.i4.542.
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Shen B. UpToDate.Diversion colitis: clinical manifestations and diagnosis.Buono AD, Carvello M, Sachar DB, et al.Diversion proctocolitis and the problem of the forgotten rectum in inflammatory bowel disease: a systemic review.United European Gastroenterol J. 2021;9(10);1157-1167. doi:10.1002/ueg2.12175American Caner Society.What is an ileostomy?NHS Inform.Ileostomy.American Cancer Society.What is a colostomy?Greenson JK, Odze, RD.Inflammatory disorders of the large intestine.Surgical pathology of the GI tract, liver, biliary tract, and pancreas. Second edition.2009.Shen, B. UpToDate.Diversion colitis: clinical manifestations and diagnosis.Greenson JK, Odze RD. Inflammatory disorders of the large intestine. Surgical pathology of the GI tract, liver, biliary tract, and pancreas. (Second edition). 2009:355-394.Tominaga K, Kamimura K, Takahashi K, et al.Diversion colitis and pouchitis: A mini-review.World J Gastroenterol.2018;24(16):1734-1747. doi:10.3748/wjg.v24.i16.1734My Crohns and Colitis Team.What is diversion colitis? 8 things to know.My Crohn’s and Colitis Team.What is diversion colitis? 8 things to know.Szczepkowski M, Banasiewicz T, Kobus A.Diversion colitis: 25 years later: the phenomenon of the disease.Int J Colorectal Dis.2017;32(8):1191-1196. doi:10.1007/s00384-017-2802-zHarig JMH, Soergel KH, Komorowski RA, Wood CM.Treatment of diversion colitis with short-chain fatty acid irrigation.N Engl J Med.1989;320:23-28.Crohn’s and Colitis Canada.Sulfasalazine and 5-AminoSalicylates (5-ASA).Towinga K, Tsuchiya A, Mizusawa T, et al.Utility of autologous fecal microbiota transplantation and elucidation of microbiota in diversion colitis.DEN Open. 2022;2(1):e63. doi:10.1002/deo2.63Additional ReadingKabir SI, Kabir SA, Richards R, Ahmed J, MacFie J. “Pathophysiology, clinical presentation and management of diversion colitis: a review of current literature.” Int J Surg. 2014;12:1088-1092. doi:10.1016/j.ijsu.2014.08.350.Son DN, Choi DJ, Woo SU, et al. “Relationship between diversion colitis and quality of life in rectal cancer.” World J Gastroenterol. 2013;19:542-549. doi:10.3748/wjg.v19.i4.542.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Shen B. UpToDate.Diversion colitis: clinical manifestations and diagnosis.Buono AD, Carvello M, Sachar DB, et al.Diversion proctocolitis and the problem of the forgotten rectum in inflammatory bowel disease: a systemic review.United European Gastroenterol J. 2021;9(10);1157-1167. doi:10.1002/ueg2.12175American Caner Society.What is an ileostomy?NHS Inform.Ileostomy.American Cancer Society.What is a colostomy?Greenson JK, Odze, RD.Inflammatory disorders of the large intestine.Surgical pathology of the GI tract, liver, biliary tract, and pancreas. Second edition.2009.Shen, B. UpToDate.Diversion colitis: clinical manifestations and diagnosis.Greenson JK, Odze RD. Inflammatory disorders of the large intestine. Surgical pathology of the GI tract, liver, biliary tract, and pancreas. (Second edition). 2009:355-394.Tominaga K, Kamimura K, Takahashi K, et al.Diversion colitis and pouchitis: A mini-review.World J Gastroenterol.2018;24(16):1734-1747. doi:10.3748/wjg.v24.i16.1734My Crohns and Colitis Team.What is diversion colitis? 8 things to know.My Crohn’s and Colitis Team.What is diversion colitis? 8 things to know.Szczepkowski M, Banasiewicz T, Kobus A.Diversion colitis: 25 years later: the phenomenon of the disease.Int J Colorectal Dis.2017;32(8):1191-1196. doi:10.1007/s00384-017-2802-zHarig JMH, Soergel KH, Komorowski RA, Wood CM.Treatment of diversion colitis with short-chain fatty acid irrigation.N Engl J Med.1989;320:23-28.Crohn’s and Colitis Canada.Sulfasalazine and 5-AminoSalicylates (5-ASA).Towinga K, Tsuchiya A, Mizusawa T, et al.Utility of autologous fecal microbiota transplantation and elucidation of microbiota in diversion colitis.DEN Open. 2022;2(1):e63. doi:10.1002/deo2.63
Shen B. UpToDate.Diversion colitis: clinical manifestations and diagnosis.
Buono AD, Carvello M, Sachar DB, et al.Diversion proctocolitis and the problem of the forgotten rectum in inflammatory bowel disease: a systemic review.United European Gastroenterol J. 2021;9(10);1157-1167. doi:10.1002/ueg2.12175
American Caner Society.What is an ileostomy?
NHS Inform.Ileostomy.
American Cancer Society.What is a colostomy?
Greenson JK, Odze, RD.Inflammatory disorders of the large intestine.Surgical pathology of the GI tract, liver, biliary tract, and pancreas. Second edition.2009.
Shen, B. UpToDate.Diversion colitis: clinical manifestations and diagnosis.
Greenson JK, Odze RD. Inflammatory disorders of the large intestine. Surgical pathology of the GI tract, liver, biliary tract, and pancreas. (Second edition). 2009:355-394.
Tominaga K, Kamimura K, Takahashi K, et al.Diversion colitis and pouchitis: A mini-review.World J Gastroenterol.2018;24(16):1734-1747. doi:10.3748/wjg.v24.i16.1734
My Crohns and Colitis Team.What is diversion colitis? 8 things to know.
My Crohn’s and Colitis Team.What is diversion colitis? 8 things to know.
Szczepkowski M, Banasiewicz T, Kobus A.Diversion colitis: 25 years later: the phenomenon of the disease.Int J Colorectal Dis.2017;32(8):1191-1196. doi:10.1007/s00384-017-2802-z
Harig JMH, Soergel KH, Komorowski RA, Wood CM.Treatment of diversion colitis with short-chain fatty acid irrigation.N Engl J Med.1989;320:23-28.
Crohn’s and Colitis Canada.Sulfasalazine and 5-AminoSalicylates (5-ASA).
Towinga K, Tsuchiya A, Mizusawa T, et al.Utility of autologous fecal microbiota transplantation and elucidation of microbiota in diversion colitis.DEN Open. 2022;2(1):e63. doi:10.1002/deo2.63
Kabir SI, Kabir SA, Richards R, Ahmed J, MacFie J. “Pathophysiology, clinical presentation and management of diversion colitis: a review of current literature.” Int J Surg. 2014;12:1088-1092. doi:10.1016/j.ijsu.2014.08.350.Son DN, Choi DJ, Woo SU, et al. “Relationship between diversion colitis and quality of life in rectal cancer.” World J Gastroenterol. 2013;19:542-549. doi:10.3748/wjg.v19.i4.542.
Kabir SI, Kabir SA, Richards R, Ahmed J, MacFie J. “Pathophysiology, clinical presentation and management of diversion colitis: a review of current literature.” Int J Surg. 2014;12:1088-1092. doi:10.1016/j.ijsu.2014.08.350.
Son DN, Choi DJ, Woo SU, et al. “Relationship between diversion colitis and quality of life in rectal cancer.” World J Gastroenterol. 2013;19:542-549. doi:10.3748/wjg.v19.i4.542.
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