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Diversion colitis is an inflammation of the colon which can occur as a complication of ileostomy or colostomy, where symptoms may occur between one month and three years following surgery. [1] It also occurs frequently in a neovagina created by colovaginoplasty, with varying delay after the original procedure. [2]
Ileostomy is a stoma (surgical opening) constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin, or the surgical procedure which creates this opening. [1] Intestinal waste passes out of the ileostomy and is collected in an external ostomy system which is placed next to
Bowel resection may be performed to treat gastrointestinal cancer, bowel ischemia, necrosis, or obstruction due to scar tissue, volvulus, and hernias. Some patients require ileostomy or colostomy after this procedure as alternative means of excretion. [1]
The Hartmann's procedure with a proximal end colostomy or ileostomy is the most common operation carried out by general surgeons for management of malignant obstruction of the distal colon. During this procedure, the lesion is removed, the distal bowel closed intraperitoneally, and the proximal bowel diverted with a stoma .
The stoma may be a gastrostomy, jejunostomy, ileostomy, or cecostomy. These may be used for feed (e.g. gastrostomy and jejunostomy) or to flush the intestines. Colostomy or ileostomy can bypass affected parts if they are distal to (come after) the stoma. For instance, if only the colon is affected, an ileostomy may be helpful.
People with symptoms that are disabling and do not respond to drugs may wish to consider whether surgery would improve the quality of life. [ 14 ] The removal of the entire large intestine, known as a proctocolectomy , results in a permanent ileostomy – where a stoma is created by pulling the terminal ileum through the abdomen.
Three parameters determine the treatment plan: the type of obstructive lesion, the blockage site (inframesocolic or supramesocolic), and the patency of the major anastomoses for the hepaticojejunostomy and pancreaticojejunostomy. The standard of care for afferent loop syndrome patients is typically surgery.
If decompression is not achieved or the patient does not improve with medical management, surgery is indicated. When surgery is required the recommended procedure is a colectomy (surgical removal of all or part of the colon) with end ileostomy. [7] Fluid and electrolyte replacement help to prevent dehydration and shock.