Treatment of diversion colitis with short-chain-fatty acid irrigation

Article Abstract:

It is occasionally necessary to remove a segment of bowel and to redirect the flow of fecal material away from its normal course. In the surgical procedure known as colostomy, the colon is brought through the muscular wall and an exit is made through the skin. Fecal material is collected in a bag which is attached over the site of the colostomy. In some cases, the remaining segment of colon or rectum below the area of the colostomy is closed and no longer has a flow of fecal material through its cavity (lumen). Diversion colitis involves frequent bleeding and generalized inflammation of the segment of large bowel which is below the redirected fecal flow. The hypothesis that this condition results from the loss of nutrients carried in the fecal mass was investigated by infusing (by enema) short-chain-fatty acids (breakdown metabolic products of fat digestion) into the affected area of rectum and colon. In this study, the four patients received a twice-daily daily irrigation of their diverted segment of bowel, and the symptoms disappeared within four to six weeks. The beneficial results were retained for up to 14 months in one patient. Endoscopic examination was used to confirm the changes in the gut and to take biopsy samples for microscopic examination. An endoscope is a periscope-like medical instrument which allows the physician to directly view the lining of the gut and to take samples. These results indicate that the large intestine may require that specific nutrients be present in their lumen for normal anatomy and function.

Health aspects, Care and treatment, Methods, Complications and side effects, Essential fatty acids, Colostomy, Irrigation (Medicine)

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A 60-year-old man with hypertrophic cardiomyopathy and ischemic colitis

Article Abstract:

A 60-year-old man was diagnosed with fibromuscular dysplasia in the arteries that supply blood to the colon. Fibromuscular dysplasia is an arterial disease that blocks the artery and prevents the flow of blood. He had begun experiencing abdominal pain in his late 50's, but colonoscopies and abdominal CT scans revealed no abnormalities. At the age of 60, he was admitted to a hospital with severe abdominal pain, diarrhea and fever. Exploratory laparotomy and colonoscopy revealed ulcers on his descending colon, which was removed. Microscopic examination of tissue samples revealed evidence of tissue damage resulting from reduced blood flow, a condition called ischemia. Angiography of his abdominal blood vessels revealed blockages in the artery that supplies blood to the colon. He was treated with balloon angioplasty. Examination of tissue samples removed during angioplasty revealed thickening and fibrosis inside the artery. The colostomy he had received during surgery was removed and his colon was re-connected.

Case studies, Intestinal ischemia

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Klebsiella oxytoca as a causative organism of antibiotic-associated hemorrhagic colitis

Article Abstract:

An in vivo animal model was developed to establish a causal link between antibiotic-associated hemorrhagic colitis and toxigenic Klebsiella oxytoca according to Koch's postulates. Koch's postulates for cytotoxin-producing Klebsiella oxytoca suggests that it is the causative organism in at least some cases of antibiotic-associated hemorrhagic colitis and infection with Klebsiella oxytoca that should be considered in patients with antibiotic-associated colitis who are negative for Clostridium difficile.

Causes of, Risk factors, Drug therapy, Klebsiella, Clostridium difficile, Clinical report

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