Successful allogeneic fecal microbiota transplantation for severe diversion colitis: a case report

Abstract

Ileostomy diverts the flow of feces, which can result in malnutrition in the distal part of the intestine. The diversity of the gut microbiota consequently decreases, ultimately leading to intestinal dysbiosis and dysfunction. This condition can readily result in diversion colitis (DC). Potential treatment strategies include interventions targeting the gut microbiota. In this case study, we effectively treated a patient with severe DC by ileostomy and allogeneic fecal microbiota transplantation (FMT). A 69-year-old man presented with a perforated malignant tumor in the descending colon and an iliac abscess. He underwent laparoscopic radical sigmoid colon tumor resection and prophylactic ileostomy. Follow-up colonoscopy 3 months postoperatively revealed diffuse intestinal mucosal congestion and edema along with granular inflammatory follicular hyperplasia, leading to a diagnosis of severe DC. After two rounds of allogeneic FMT, both the intestinal mucosal bleeding and edema significantly improved, as did the diversity of the gut microbiota. The positive outcome of allogeneic FMT in this case highlights the potential advantages that this procedure can offer patients with DC. However, few studies have focused on allogeneic FMT, and more in-depth research is needed to gain a better understanding.

Keywords: Diversion colitis; case report; colonic tumor; enterostomy; fecal microbiota transplantation; gut microbiota.

Figure 1.

Computed tomography findings in the upper and lower abdomen.

Figure 2.

Hematoxylin and eosin staining results: cytokeratin (+) and carcinoembryonic antigen (partly +) (40×).

Figure 3.

Enteroscopic observations. (a–d) Before fecal microbiota transplantation. (e–h) After fecal microbiota transplantation. Intestinal mucosal inflammatory damage score: 7 points (mucosal hemorrhage: 3 points, contact hemorrhage: 1 point, edema: 3 points).

Figure 4.

Diagram of ileostomy placement.

Figure 5.

Comparison of gut microbiota in fecal samples before and after fecal microbiota transplantation. (a) Shannon Index. (b) Relative abundance of gut bacteria at phylum level and (c) relative abundance of gut bacteria at genus level.