Acute Ulcerative Colitis Flare Following Diversion in Patients with Inflammatory Bowel Disease

Abstract Surgery remains a part of the treatment for inflammatory bowel disease despite recent advances in medical management. Although most acute flares are managed medically, some are severe enough that surgical treatment is needed to control them. Historically, diverting loop ileostomy creation was utilized to allow for a “cool off” of the colon, with the goal of organ preservation. Recent data show that it remains an option, even in the era of modern medicine. There have been some reports of worsening ulcerative colitis despite diversion. This phenomenon is not well understood, with postoperative conditions such as ischemia, changes in bacterial flora, and emotional distress proposed as mechanisms. We present a case of a patient with IBD who developed an acute flare post-surgery with diversion that could not be controlled medically and ultimately required proctocolectomy.