Diversion colitis and pouchitis: A mini-review

Table 2 Clinical course of case reports

Case (No)	Ref.	Age (yr)	Gender(male/female)	Ineffective treatment	Effective treatment	Prognosis
1	Glotzer et al[2]	49	M	N/A	Closure 4 mo post-diversion	Asymptomatic. Proctoscopy and biopsy normal 2.5 and 30 mo postclosure.
		56	F	N/A	Closure 3 mo post-diversion	Recurrent Ca. Mucosa not inflamed grossly or microscopically 18 mo post closure.
		78	M	N/A	Closure 6 mo post-diversion	Asymptomatic 1 yr postclosure.
		70	F	N/A	Closure 5 mo post-diversion	Asymptomatic. Normal sigmoidoscopy 2 mo postclosure.
		43	F	N/A	Closure 2 yr post-diversion	Asymptomatic. Normal sigmoidoscopy 3 yr postclosure.
		41	F	N/A	None	Asymptomatic 2 yr after ileostomy.
		65	M	N/A	None	Abdominal cramps purulent rectal discharge. Continued inflammation 8 yr after colostomy.
		83	M	N/A	None	Asymptomatic. Continued mild inflammation 4.5 yr after colostomy.
		26	M	N/A	Steroid enemas	Inproved. Continued 8 yr after colostomy.
		70	M	N/A	Steroid enemas	Tenesmus, discharge and fever 4 yr after colostomy. Resolved with steroid enemas. Continued inflammation at 8 yr.
2	Lusk et al[39]	28	M	-	Colostomy closure	Normal at 16 mo follow-up.
		68	M	-	Colostomy closure	Normal at 7 wk after clousure.
3	Scott et al[46]	21	M	-	Colostomy closure	One month later, the patient was examined by flexible sigmoidoscopy, which demonstrated normal mucosa throughout with no sign of pseudopolyps.
4	Korelitz et al[42]	22	F	Steroid enemas	Ileocolic reanastomosis (ileostomy closure)	3 mo (interval from reanastomosis to normal sigmoidoscopy), 7 yr (duration normal).
		34	F	-	Ileostomy closure	1 mo (interval from reanastomosis to normal sigmoidoscopy), 2 yr (duration normal).
		31	M	-	Ileostomy closure	3 mo (interval from reanastomosis to normal sigmoidoscopy), 18 mo (duration normal).
		32	M	-	Ileostomy closure	2 mo (interval from reanastomosis to normal sigmoidoscopy), 14 mo (duration normal).
5	Fernand et al[40]	67	F	-	Left hemicolectomy and left salpingo-oophorectomy	She recoverd well and discharged 9 d later.
6	Frank et al[13]	38	M	Oral and topical steroids	Abdominoperineal resection of the diverted loop and permanent colostomy	No evidence of inflammatory bowel disease has developed. Barium study of the small bowel was normal 1 yr after surgery.
7	Harig et al[5]	63	M	N/A	Short-chain-fatty acid irrigation	N/A
		63	F	N/A	Short-chain-fatty acid irrigation	N/A
		54	M	N/A	Short-chain-fatty acid irrigation	N/A
		56	M	N/A	Short-chain-fatty acid irrigation	N/A
8	Triantafillidis et al[31]	64	F	-	5 aminosalicylic acid enemas comparison with Betamethasone enemas	There were no differences in the degree of clinical improvement, or in the endoscopic and histologic scores seen at the end of the trials, between betamethasone and 5-ASA.
9	Tripodi et al[43]	85	F	-	5-aminosalicylic acid enemas	Clinically asymptomatic at a 6-mo follow-up.
10	Lu et al[38]	45	F	Intravenous metronidazole	Colectomy of the diverted segment	Without complications and has been doing well postoeratively.
11	Lai et al[47]	49	M	-	Daily 5-ASA suppository and total parenteral nutrition	6 wk of treatment with 5-ASA, the patient had decreased rectal pain and bleeding.
12	Lim et al[32]	60	F	-	Oral prednisolone, oral mesalazine, and mesalazine enemas	PSL was tapered off over four months and she remained well.
		0	M	Closure of the loop ileostomy→oral prednisolone, oral olsalazine and oral metronidazole→sigmoid loop colostomy	The defunctioned rectosigmoid was partially removed, leaving the lower rectum and anal canal; the loop colostomy was refashioned into an end colostomy→colectomy and removal of residual rectal stump and anal canal was performed and an end ileostomy fashioned	He subsequently made a good recovery and steroid therapy was discontinued.
13	Jowett et al[33]	75	F	-	Topical steroid enemas.	UC
14	Lim et al[35]	66	M	-	Steroid enemas	6 mo later he developed ulcerative colitis.
15	Kiely et al[36]	6	M	PSL and AZA	SCFA	Oral PSL was continued at the reduced rate of 5mg on alternate days until he underwent an uneventful rectal excision and J-pouch anal anastomosis 1 mo later. Two months after this, his ileostomy was closed.
		3	M	Salazopyrine	SCFA	His ileostomy was closed 3 mo later, and he was remained symptom free.
		8	F	-	SCFA	Her ulceration was virtually healed and showed a reduction in endoscopic index from 9 to 3. Treatment was maintained until her colostomy was reversed a month later. After stoma closure, SCFAs were discontinued with no further recurrence of symptoms.
		3	M	N/A	SCFA	For redo pull-through
		10	M	N/A	SCFA	Rectal excision
16	Komuro et al[41]	46	M	-	-	The post endoscopic course was uneventful without any treatment.
17	Tsironi et al[48]	40	M	Mesalazine suppository and steroid enemas	Metronidazole suppository	Improved quickly and remains well and asymptomatic 12 wk after treatment.
18	Boyce et al[37]	29	M	-	Completion proctectomy	Completion proctectomy was uneventful and from which the patient made an unremarkable recovery.
19	Haugen et al[49]	36	F	The water and vinegar solution enema, steroid enema, bismuth subsalicylate (standard treatment SCFA enmas was not option due to insurance and spina bifida)	Antegrade irrigations of her distal bowel with tap water	Weekly to twice weekly irrigations completely stopped the malodorous and troublesome discharge.
20	Talisetti et al[50]	19	F	SCFA enema, steroids, metronidazole	Colectomy(entire colon was ultimately resected, Since only 15 cm of jejunum appeared healthy, her mid and distal small bowel was also resected up to 15 cm from the ligament of Treitz)	N/A
21	Kominami et al[51]	84	M	Short-chain fatty acid enema	5-aminosalicylic acid enemas	Undergoing 5-aminosalicylic acid enemas maintenance therapy.
22	Watanabe et al[44]	76	F	Oral mesalazine, corticosteroid, metronidazole, and ciprofloxacin	Leukocytapheresis, following low dose of metronidazole and ciprofloxacin	After 18 mo, her condition remains stable without the need for medication.
23	Gundling et al[45]	75	F	Enemas containing 5-aminosalicylic acid and steroids and antibiotic therapy	Autologous fecal transplantation	All symptoms improved dramatically within 5 d after the first treatment. Colonoscopy 28 d after the first treatment showed no major signs of inflammation in the colonic stump.
24	Matsumoto et al[52]	65	M	Corticosteroid and mesalazine enemas, prednisolone injections.	A combined mesalazine plus corticosteroid enema	Finally proctectomy and ileal pouch-anal anastomosis were successfully performed.
25	Custon et al[29]	44	M	-	Dextrose( hypertonic glucose ) spray endoscopically	The patient did not experience further episodes of recurrent bleeding during the 6-mo follow-up. No prescribed medicines were given after the endoscopic therapy.