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Diversion Colitis-A case report-

대한대장항문학회지 1998년 14권 3호 p.661 ~ 666
이준규 ( Lee Jun-Kyu ) - 연세대학교 의과대학 내과학교실

이충렬 ( Lee Chung-Ryul ) - 연세대학교 의과대학 내과학교실
조용석 ( Jo Young-Seok ) - 연세대학교 의과대학 내과학교실
유효민 ( Yoo Hyo-Min ) - 연세대학교 의과대학 내과학교실
김원호 ( Kim Won-Ho ) - 연세대학교 의과대학 내과학교실
민진식 ( Min Jin-Sik ) - 연세대학교 의과대학 외과학교실
기정혜 ( Ki Jung-Hae ) - 연세대학교 의과대학 병리학교실
김호근 ( Kim Ho-Keun ) - 연세대학교 의과대학 병리학교실

Abstract


Diversion colitis is an inflammatory process that occurs in the excluded segments of the colorectum after surgical diversion of fecal stream, such as ileostomy or colostomy. The incidence of diversion colitis is reported as high as 100%, when observed prospectively, and the symptoms occur typically from 3 to 36 months after diverting surgery. The majority of patients are usually asymptomatic, but up to 50% of patients complains of abdominal pain, mucous discharge, and sometimes bloody diarrhea. Endoscopic appearance of diversion colitis has a broad spectrum of possible appearances from being normal to showing signs of severe inflammation, such as mucosal erythema, edema, friability, granularity or nodularity, aphthous ulceration, bleeding or strictures. The histopathologic changes are diffuse nonspecific acute and chronic inflammation, crypt distortion, crypt abscess, lymphoid follicular hyperplasia in excluded segments of colorectum. The choice of treatment is reanastomosis. After reanastomosis, most patients have symptomatic improvement and the excluded segments of colorectum will be normalized endoscopically and histologically. When the underlying condition does not allow reanastomosis, the symptomatic treatment such as mixed short-chain fatty acid solution enemaor instillation should be helpful. We experienced a case of diversion colitis 18 months after low anterior resection and transverse loop colostomy due to rectal cancer.

키워드

Diversion colitis;Fecal diversion;Short-chain fatty acid;N-butyrate
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