Diversion proctitis after Hartmann's procedure

What is known

• After Hartmann's procedure, ~70% of CD patients develop disease in the rectal remnant and ~50% require completion proctectomy within 10 years. ¹
• Diversion proctitis is a frequently reported rectal-stump complication in IBD, but evidence on its incidence is explicitly noted as limited, particularly in Crohn's disease. ²
• In a multicenter CD cohort, nearly half of patients carrying a retained rectum >6 months required proctectomy, with 30–68% proctectomy rates across five prior studies. ³
• Proctitis was identified as a risk factor for unsuccessful restoration of continuity and for permanent diversion. ⁴

What is unknown / caveats

• Excerpts quantify rectal-remnant disease and proctectomy rates, not diversion proctitis incidence as a discrete endpoint
• Diversion proctitis and CD proctitis of the stump are often conflated in these reports
• A precise incidence figure for diversion proctitis specifically is not established in the retrieved literature, sources call the evidence limited.

References

1. Leinicke JA, Dietz DW. Reoperative Surgery in Complex Crohn's Disease. Clin Colon Rectal Surg. 2019;32(4):291-299. PMID: 31275076.

2. Ten Hove JR, Bogaerts JMK, Bak MTJ, Laclé MM, Meij V, Derikx LAAP, Hoentjen F, Mahmmod N, van Tuyl SA, Oldenburg B. Malignant and Nonmalignant Complications of the Rectal Stump in Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis. 2019;25(2):377-384. PMID: 30085111.

3. Kassim G, Yzet C, Nair N, Debebe A, Rendon A, Colombel JF, Traboulsi C, Rubin DT, Maroli A, Coppola E, Carvello MM, Ben David N, De Lucia F, Sacchi M, Danese S, Spinelli A, Hirdes MMC, Ten Hove J, Oldenburg B, Cholapranee A, Riter M, Lukin D, Scherl E, Eren E, Sultan KS, Axelrad J, Sachar DB. Long-Term Outcomes of the Excluded Rectum in Crohn's Disease: A Multicenter International Study. Inflamm Bowel Dis. 2023;29(3):417-422. PMID: 35522225.

4. Lightner AL, Buhulaigah H, Zaghiyan K, Holubar SD, Steele SR, Jia X, McMichael J, Vaidya P, Fleshner PR. Is Intestinal Diversion an Effective Treatment for Distal Crohn's Disease?. Inflamm Bowel Dis. 2022;28(4):547-552. PMID: 34076248.

For educational use only, not a substitute for clinical judgement or medical advice. Consult qualified clinicians for diagnosis and treatment decisions. This tool may contain errors; use the flag button below to report inaccurate or harmful content.

Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.