Diversion colitis is a condition that sometimes occurs after colostomy or ileostomy surgery. Colitis is the medical term that’s used to refer to inflammation in the large intestine (colon). 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 have inflammatory bowel disease (IBD). This condition may also be called diversion proctitis if the rectum is affected.
The treatment of choice is surgical reanastomosis. In patients who are not surgical candidates, medical therapies which have shown benefit include SCFA enemas, immunosuppression (e.g. topical mesalazine, systemic glucocorticoids), and fecal microbiota transplantation. Empiric antibiotics may also be used, especially in cases of pouchitis which may initially be thought to be infective and thus antibiotic-responsive, although this is not the case in true diversion pouchitis which typically does not respond to antibiotics.