Diversion Colitis Resulting in Perforation and Abscess Formation

Introduction/Purpose: Diversion colitis is a well described condition in patients after colostomy in which the de-functioned segment of colon undergoes microscopic or macroscopic inflammatory changes. Symptoms are typically only present in one third of patients and include bleeding per rectum, abdominal pain, and tenesmus. This is the first reported case of perforation and abscess involving a de-functioned segment of colon.

Methods or Case Description: A 67 year-old male with a past surgical history significant for end colostomy with mucous fistula creation secondary to severe diverticular disease presented to ER with abdominal pain and fever. CT abdomen and pelvis demonstrated a retroperitoneal abscess communicating with the adjacent de-functioned descending colon.

Outcomes: The patient was treated conservatively with antibiotics and CT guided drainage. One week later, the drain was interrogated and demonstrated resolution of the fluid collection with no communication to the retroperitoneum. The drain was subsequently removed.

Conclusion: While symptomatic diversion colitis occurs in up to one third of patients with de-functioned colon, the phenomenon of perforation and abscess formation has never been described prior to this case report.