Diversion colitis presenting with massive rectal distension and bilateral ureteric obstruction

摘要

Diversion of the faecal stream with the distal colon left in situ can occur following both elective and emergency surgery for colonic disease. Whether the excluded colon is subsequently removed or continuity restored is variable. In patients undergoing subtotal colectomy for colitis, the majority will undergo a further procedure, either a restorative ileroectal anastomosis or completion proctectomy,with or without an ileoanal pouch. Amongst those patients who undergo Hartmann's procedure, the rates of reversal varies widely, but a significant proportion will not undergo further surgery and remain with a permanent colostomy and rectal stump. In patients undergoing elective anterior resection of the rectum for adenocarcinoma, a significant proportion of patients will have a permanent stoma with distal colon in situ. Both acute and chronic complications may result from the redundant distal colon. In the acute postoperative period, such complications include pelvic sepsis resulting from rectal stump dehiscence.Chronic complications, which are more common in those in whom the original surgery was for inflammatory bowel disease, include on-going disease activity in the rectum, and in the long term, dysplastic changes and carcinoma. Where the original pathology was not inflammatory, those with a rectal stump may develop non-specific inflammatory changes in the rectum, so-called diversion colitis, as a consequence of diversion of the faecal stream. Diversion colitis may present with abdominal pain, bleeding and discharge. Here, we describe the late presentation of inflammatory change within a rectal stump resulting inmassive distension of the rectum and significant haemorrhage. The rectal distension caused bladder outflow obstruction, bilateral hydronephrosis and acute renal failure requiring bilateral nephrostomies.