S3821 Clinical Utility of PuraStat in the Management of Symptomatic Diversion Colitis

Introduction: Diversion colitis is an inflammatory condition that develops in segments of the colon following colonic diversion of the fecal stream. The prevalence of diversion colitis following colonic diversion is high and can lead to complications such as rectal bleeding. Symptomatic individuals are managed primarily with surgery however other modalities have been explored for poor surgical candidates. In symptomatic patients, restoring intestinal continuity by surgical reanastomosis is the recommended first line treatment. However pharmacological therapies are necessary for poor surgical candidates. PuraStat (3-D Matrix) is a novel hemostatic gel composed of self-assembling peptides. We present the first case of successful management in diversion colitis following the application of a synthetic peptide gel approved for bleeding in the gastrointestinal tract, PuraStat. Case Description/Methods: A 73-year-old man with history of complicated diverticulitis requiring multiple bowel surgeries that resulted in a permanent ileostomy with a Hartmann’s pouch presented with a few months of painless rectal bleed. He developed acute anemia with a decline in hemoglobin. A pouchoscopy was performed revealing multiple bleeding lesions consistent with angioectasias. The bleeding lesions were biopsied and managed with PuraStat for hemostasis. Pathology revealed histological findings consistent with diversion colitis. A follow up pouchoscopy a few weeks later revealed healed and normal appearing Hartmann’s pouch mucosa. Discussion: Individuals with diversion colitis may experience a wide range of symptoms such as tenesmus, abdominal pain, mucus discharge, or rectal bleeding which can contribute towards anxiety, excess stress, and other various negative quality of life measures. The management for diversion colitis is focused on the reduction and elimination of such symptoms. Although surgical reanastomosis remains the primary treatment modality for symptomatic individuals, there remains a population who are poor candidates for surgery who can be managed with various pharmacologic therapies. A few pharmacologic therapies include short chain fatty acid enemas, immunosuppressive agents such as topical 5-aminosalicylic acid agents, topical glucocorticoids, fecal transplantation, and dextrose spray. PuraStat should be considered as a treatment for symptomatic diversion colitis as it offers advantages over other conventional modalities with versatility, immediate therapy, and reassurance with treatment nonadherance.