Overview
Diversion colitis refers to inflammation of the gastrointestinal tract resulting from fecal diversion, often seen in patients with a permanent or long-term colostomy or ileostomy 4.Diagnosis
Identification of chronic diarrhea, abdominal pain, and signs of colitis in patients with fecal diversion 4.
Endoscopic findings showing mucosal inflammation consistent with colitis 4.
Histopathological examination revealing characteristic inflammatory changes in biopsy samples 4.Management
No specific first-line pharmacological treatments mentioned; management often focuses on supportive care and addressing underlying causes 4.
Monitoring and managing complications such as nutritional deficiencies and infections 4.
Consider surgical revision or reversal of the diversion if feasible and appropriate 4.Special Populations
No specific guidance provided for pregnancy, pediatrics, or elderly patients in the given abstracts 34.
Patients with multiple comorbidities may require tailored surgical approaches like sigmoidoscopy-assisted colostomy for safer fecal diversion 3.Key Recommendations
Implement comprehensive surveillance systems using information management databases to detect atypical drug transactions indicative of diversion 2 (Evidence: Moderate).
Establish multidisciplinary teams including pharmacy, safety, nursing, and legal departments to prevent and detect drug diversion effectively 1 (Evidence: Expert opinion).
Vigilantly monitor patients with fecal diversion for signs of diversion colitis, including chronic gastrointestinal symptoms and endoscopic findings 4 (Evidence: Weak).References
1 Berge KH, Dillon KR, Sikkink KM, Taylor TK, Lanier WL. Diversion of drugs within health care facilities, a multiple-victim crime: patterns of diversion, scope, consequences, detection, and prevention. Mayo Clinic proceedings 2012. link
2 Epstein RH, Gratch DM, Grunwald Z. Development of a scheduled drug diversion surveillance system based on an analysis of atypical drug transactions. Anesthesia and analgesia 2007. link
3 Beilman GJ, Jonson GM. Sigmoidoscopy-assisted colostomy--an adapted trephine stoma formation. Digestive surgery 2002. link
4 Griffiths AP, Dixon MF. Microcarcinoids and diversion colitis in a colon defunctioned for 18 years. Report of a case. Diseases of the colon and rectum 1992. link