Diversion colitis

Option E

This patient has diversion colitis which developed after the diverting colostomy. Symptoms typically develop within 3-36 months after the diverting procedure and include rectal bleeding, tenesmus, anorectal pain, and crampy lower abdominal discomfort. The differential diagnosis is generally between diversion colitis and IBD, although in this patient the possibility of radiation proctitis is raised by the history of radiation for prostate cancer 6 years prior. However, the endoscopic findings are more consistent with a diagnosis of diversion colitis (absence of telangiectasia, etc.). The first three treatment options represent endoscopic therapies for radiation proctitis. Although medical therapy such as cort enemas, 5-ASA enemas, and short-chain fatty acid enemas have been used with some success in diversion colitis, the treatment of choice is surgical reanastomosis and the symptoms should resolve within a few weeks after surgery

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