Diversion procto-colitis: Response to treatment with short-chain fatty acids

Background/Purpose: Diversion procto-colitis (DPC) results from a deficiency of luminal short-chain fatty acids (SCFAs). Endoscopic and histopathologic features of the disorder are almost universally present in defunctioned bowel, but symptomatic DPC is less common. Methods: Five children with symptomatic DPC underwent endoscopy and rectosigmoid biopsies. An endoscopic index (El) was used to quantify disease severity. An SCFA mixture was administered into the defunctioned bowel. Results: A good clinical response and improvement in the endoscopic index occurred in all children. Undiversion or rectal excision was carried out in 4 and was curative in each case. One child is awaiting a redo pull through. Conclusions: DPC should be considered in children with a defunctioned colon presenting with evidence of colitis. Histopathology provides supportive evidence and SCFAs may provide effective relief of symptoms. Stoma reversal or rectal excision is curative. Copyright (C) 2001 by W B. Saunders Company.