gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-2002Research ArticleНОВОСТИ КОЛОПРОКТОЛОГИИNEWS OF COLOPROCTOLOGYКолит отключенной толстой кишки (Обзор литературы)Diversion colitis (Review of the literature)ВоробьевГ. И.Vorob’yevG. I.ЖученкоА. П.ZhuchenkoA. P.ФилонА. Ф.FilonA. F.КитчиеваГ. М.KitchiyevaG. M.2008260920081856570Copyright © Воробьев Г.И., Жученко А.П., Филон А.Ф., Китчиева Г.М., 20082008Воробьев Г.И., Жученко А.П., Филон А.Ф., Китчиева Г.М.Vorob’yev G.I., Zhuchenko A.P., Filon A.F., Kitchiyeva G.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/2002

Цель обзора. Изучение колита отключенной толстой кишки (КОТК) и его влияния на результаты реконструктивно­восстановительных вмешательств на толстой кишке.Последние данные литературы. Колит отключенной толстой кишки – это воспалительное заболевание, поражающее отключенную ободочную и/или прямую кишку с развитием морфологической картины неинфекционного колита. Различные авторы утверждают, что ведущую роль в патогенезе КОТК следует отводить удалению из просвета кишки короткоцепочечных жирных кислот (КЦЖК). На сегодняшний день нет убедительных данных о предпочтении какого-­либо из методов консервативной терапии КОТК, что лишний раз свидетельствует о сложности его патогенеза и необходимости интенсивного изучения указанной проблемы как колопроктологами, так и гастроэнтерологами. Одним из важных факторов в понимании этого патологического процесса является однозначно положительное влияние восстановления естественного пассажа кишечного содержимого по отключенным отделам кишки. При этом целесообразно проведение пред­операционной терапии, направленной на уменьшение степени выраженности воспаления.Заключение. Для повышения эффективности лечения КОТК необходимы дальнейшие исследования по применению препаратов КЦЖК, противовоспалительных средств в схеме предоперационной подготовки больных к реконструктивно-­восстановительным операциям.

The aim of review

The aim of review. To study issues of diversion colitis and its effect on results of reconstructive interventions on the large intestine.

Recent literature data

Recent literature data. The diversion colitis is the inflammatory disease, that develops in defunctioned colon and/or rectum with histological pattern of noncontagious colitis. Different authors claim, that elimination of short-chain fatty acids (SCFA) from intestinal lumen plays the leading role in pathogenesis of diversion colitis. Up to now, there are no convincing data on preference any of methods of conservative therapy for diversion colitis, that as well proves complexity of its pathogenesis and necessity of intensive studying of this problem by both coloproctologists and gastroenterologists. Definite positive effect of restoration of natural passage of intestinal contents through excluded region is an important factor in comprehension of this pathological process. Preoperative therapy decreasing degree of inflammation is necessary.

Conclusion

Conclusion. Further studies on application of SCFA preparations, anti-inflammatory drugs in preparation to reconstructive operations are necessary to improve efficacy of diversion colitis treatment.

колостомаколиткороткоцепочечные жирные кислотывоспалениелимфоплазмоцитарная инфильтрацияcolostomacolitisshort-chain fatty acidsinflammationlymphoplasmacytic infiltrationReferencesБелобородова Н.В., Белобородов С.М. Метаболиты анаэробных бактерий (летучие жирные кислоты) и реактивность макроорганизма // Антибиотикотерапия и химиотерапия. – 2000. – № 2. – С. 28–36.Белобородова Н.В., Белобородов С.М. Метаболиты анаэробных бактерий (летучие жирные кислоты) и реактивность макроорганизма // Антибиотикотерапия и химиотерапия. – 2000. – № 2. – С. 28–36.Шендеров Б.А. Медицинская микробная экология и функциональное питание. – М., 1998. – С. 1–111.Шендеров Б.А. Медицинская микробная экология и функциональное питание. – М., 1998. – С. 1–111.Abbasakoor F., Mahon C., Boulos P.B. Diversion colitis in sigmoid neovagina // Colorectal Dis. – 2004. – Vol. 6. – P. 290–291.Abbasakoor F., Mahon C., Boulos P.B. Diversion colitis in sigmoid neovagina // Colorectal Dis. – 2004. – Vol. 6. – P. 290–291.Charles P., Orsay M.D., Donq O. et al. Diversion colitis in patients scheduled for colostomy closure // Dis. Colon Rectum. – 1993. – Vol. 36. – P. 366–367.Charles P., Orsay M.D., Donq O. et al. Diversion colitis in patients scheduled for colostomy closure // Dis. Colon Rectum. – 1993. – Vol. 36. – P. 366–367.De Olivera-Neto J.P., De Aguilar-Nascimento J.E. Intraluminal irrigation with fibers improves mucosal inflammation аnd atrophy in diversion colitis // Nutrition. – 2004. – Vol. 20, N 2. – P. 197–199.De Olivera-Neto J.P., De Aguilar-Nascimento J.E. Intraluminal irrigation with fibers improves mucosal inflammation аnd atrophy in diversion colitis // Nutrition. – 2004. – Vol. 20, N 2. – P. 197–199.Drut R., Drut R.M. Hyperplasia of lymphoglandular complexec in colon segments in Hirschsprung s disease: a form of diversion colitis // Pediatr. Pathol. – 1992. – Vol. 12, N 4. – P. 575–581.Drut R., Drut R.M. Hyperplasia of lymphoglandular complexec in colon segments in Hirschsprung s disease: a form of diversion colitis // Pediatr. Pathol. – 1992. – Vol. 12, N 4. – P. 575–581.Edwards C.M., George B., Warren B. Diversion colitis-new light through old windows // Histopathology. – 1999. – Vol. 34, N 1. – P. 1–5.Edwards C.M., George B., Warren B. Diversion colitis-new light through old windows // Histopathology. – 1999. – Vol. 34, N 1. – P. 1–5.Feakins R.M. Diversion proctocolitis with granulomatous vasculitis in a patients without inflammatory bowel disease // Histopathology. – 2000. – Vol. 36. – P. 88–93.Feakins R.M. Diversion proctocolitis with granulomatous vasculitis in a patients without inflammatory bowel disease // Histopathology. – 2000. – Vol. 36. – P. 88–93.Ferguson C.M., Siegel R.J. A prospective evaluation of diversion colitis // Am. Surg. – 1991. – Vol. 57, N 1. – P. 46–49.Ferguson C.M., Siegel R.J. A prospective evaluation of diversion colitis // Am. Surg. – 1991. – Vol. 57, N 1. – P. 46–49.Frisbie J.H., Ahmed N., Hiraho I. et al. Diversion colitis in patients with myelopathy: clinical, endoscopic, and hispatological findings // J. Spinal Cord Med. – 2000. – Vol. 23, N 2. – P. 142–149.Frisbie J.H., Ahmed N., Hiraho I. et al. Diversion colitis in patients with myelopathy: clinical, endoscopic, and hispatological findings // J. Spinal Cord Med. – 2000. – Vol. 23, N 2. – P. 142–149.Giardiello F.M., Lazenby A.J., Bayless T.M. The new cilitides, collagenous, lymphocytic, and diversion colitis // Gastroenterol. Clin. North Am. – 1995. – Vol. 24, N 3. – P. 717–729.Giardiello F.M., Lazenby A.J., Bayless T.M. The new cilitides, collagenous, lymphocytic, and diversion colitis // Gastroenterol. Clin. North Am. – 1995. – Vol. 24, N 3. – P. 717–729.Glotzer D.J., Glick M.E., Goldman H. Proctitis and colitis following diversion of the fecal stream // Gastroenterology. – 1981. – Vol. 80, N 3. – P. 438–441.Glotzer D.J., Glick M.E., Goldman H. Proctitis and colitis following diversion of the fecal stream // Gastroenterology. – 1981. – Vol. 80, N 3. – P. 438–441.Grant N.J., van Kruiningen H.J., Hague S. West A.B. Mucosal inflammation in pediatric diversion colitis: a quantitative analysis // J. Pediatr. Gastroenterol. Nutr. – 1997. – Vol. 25, N 3. – P. 273–280.Grant N.J., van Kruiningen H.J., Hague S. West A.B. Mucosal inflammation in pediatric diversion colitis: a quantitative analysis // J. Pediatr. Gastroenterol. Nutr. – 1997. – Vol. 25, N 3. – P. 273–280.Griffiths A.Р., Dixon M.F. Microcarcinoids and diversion colitis in a colon defunctioned for 18 years. Report of a case // Dis. Colon Rectum. – 1992. – Vol. 35, N 7. – P. 685–688.Griffiths A.Р., Dixon M.F. Microcarcinoids and diversion colitis in a colon defunctioned for 18 years. Report of a case // Dis. Colon Rectum. – 1992. – Vol. 35, N 7. – P. 685–688.Guillemot F., Colombel J.F., Neut C. et al. Treatment of diversion colitis by short chain fatty acids. Prospective and double-blind study // Dis. Colon Rectum. – 1991. – Vol. 34, N 10. – P. 861–864. Comment in: Dis. Colon Rectum. – 1992. – Vol. 35, N 5. – P. 511–512.Guillemot F., Colombel J.F., Neut C. et al. Treatment of diversion colitis by short chain fatty acids. Prospective and double-blind study // Dis. Colon Rectum. – 1991. – Vol. 34, N 10. – P. 861–864. Comment in: Dis. Colon Rectum. – 1992. – Vol. 35, N 5. – P. 511–512.Haas P.A., Fox T.A.Jr., Szilagy E.J. Endoscopic examination of the colon and rectum distal to a colostomy // Am. J. Gastroenterol. – 1990. – Vol. 85, N 7. – P. 850–854.Haas P.A., Fox T.A.Jr., Szilagy E.J. Endoscopic examination of the colon and rectum distal to a colostomy // Am. J. Gastroenterol. – 1990. – Vol. 85, N 7. – P. 850–854.Hague S., Eisen R.N., West A.B. The morphologic features of diversion colitis: studies of a pediatric population with no other disease of the intestinal mucosa // Hum. Pathol. 1993. – Vol. 24, N 2. – P. 211–219. Comment in: Hum. Pathol. – 1993. – Vol. 24, N 10. – P. 1150.Hague S., Eisen R.N., West A.B. The morphologic features of diversion colitis: studies of a pediatric population with no other disease of the intestinal mucosa // Hum. Pathol. 1993. – Vol. 24, N 2. – P. 211–219. Comment in: Hum. Pathol. – 1993. – Vol. 24, N 10. – P. 1150.Hague S., West A.B. Diversion colitis – 20 years growing // J. Clin. Gastroenterol. – 1992. – Vol. 15, N 4. – P. 281–283.Hague S., West A.B. Diversion colitis – 20 years growing // J. Clin. Gastroenterol. – 1992. – Vol. 15, N 4. – P. 281–283.Harig J.M., Sergeel K.H., Komorowski R.A., Wood C.M. Treatment of diversion colitis with short chain fatty acid irrigation // N. Engl. J. Med. – 1989. – Vol. 320, N 1. – P. 23–28.Harig J.M., Sergeel K.H., Komorowski R.A., Wood C.M. Treatment of diversion colitis with short chain fatty acid irrigation // N. Engl. J. Med. – 1989. – Vol. 320, N 1. – P. 23–28.Kealy W.F. Colonic lymphoid – glandular complex (microbursa): nature and morphology // J. Clin. Pathol. – 1976. – Vol. 3. – P. 241–244.Kealy W.F. Colonic lymphoid – glandular complex (microbursa): nature and morphology // J. Clin. Pathol. – 1976. – Vol. 3. – P. 241–244.Kiely E.M., Ajayi N.A., Wheeler R.A., Malone M. Diversion proctocolitis: response to treatment with short chain fatty acids // J. Pediatr. Surg. – 2001. – Vol. 36, N 10. – P. 1514–1517.Kiely E.M., Ajayi N.A., Wheeler R.A., Malone M. Diversion proctocolitis: response to treatment with short chain fatty acids // J. Pediatr. Surg. – 2001. – Vol. 36, N 10. – P. 1514–1517.Lai J.M., Chuang T.Y., Francisco G.E., Stayer J.R. Diversion colitis: a canse of abdominal discomfort in spinal cord injury patients with colostomy // Arch. Phys. Med. Rehabil. – 1997. – Vol. 78, N 6. – P. 670–671.Lai J.M., Chuang T.Y., Francisco G.E., Stayer J.R. Diversion colitis: a canse of abdominal discomfort in spinal cord injury patients with colostomy // Arch. Phys. Med. Rehabil. – 1997. – Vol. 78, N 6. – P. 670–671.Lavoine E., Vissuzane C., Cadiot G. et al. Proctitis of diversion on an excluded rectum in patients with hemorrhagic rectocolitis // Gastroenterol. Clin. Biol. – 1996. – Vol. 20, N 3. – P. 243–247.Lavoine E., Vissuzane C., Cadiot G. et al. Proctitis of diversion on an excluded rectum in patients with hemorrhagic rectocolitis // Gastroenterol. Clin. Biol. – 1996. – Vol. 20, N 3. – P. 243–247.Lechner G.L., Frank W., Jantsch H. et al. Lymphoid follicular hyperplasia in excluded colonic segments: a radiologic sign of diversion colitis // Radiology. – 1990. – Vol. 176, N 1. – P. 135–136.Lechner G.L., Frank W., Jantsch H. et al. Lymphoid follicular hyperplasia in excluded colonic segments: a radiologic sign of diversion colitis // Radiology. – 1990. – Vol. 176, N 1. – P. 135–136.Lim A.G., Lim W. Diversion colitis; a trigger for ulcerative colitis in the intstream colon // Gut. – 1999. – Vol. 44. – P. 279–282.Lim A.G., Lim W. Diversion colitis; a trigger for ulcerative colitis in the intstream colon // Gut. – 1999. – Vol. 44. – P. 279–282.Lu E.S., Lin T., Harms B.L. et al. A sever case of diversion colitis with large ulcerations // Am. J. Gastroenterol. – 1995. – Vol. 90, N 9. – P. 1508–1510.Lu E.S., Lin T., Harms B.L. et al. A sever case of diversion colitis with large ulcerations // Am. J. Gastroenterol. – 1995. – Vol. 90, N 9. – P. 1508–1510.Ma C.K., Gottlieb C., Haas P.A. Diversion colitis: a clinicopathologic study of 21 cases // Hum. Pathol. – 1990. – Vol. 21, N 4. – P. 429–436.Ma C.K., Gottlieb C., Haas P.A. Diversion colitis: a clinicopathologic study of 21 cases // Hum. Pathol. – 1990. – Vol. 21, N 4. – P. 429–436.Morson B.C., Dawson I.M.P. Gastrointestinal pathology. – 1st ed. – London: Blackwell Scientific Publications, 1972. – 485 p.Morson B.C., Dawson I.M.P. Gastrointestinal pathology. – 1st ed. – London: Blackwell Scientific Publications, 1972. – 485 p.Murray F.E., O’Brien M.J., Birkett D.H. et al. Diversion colitis. Pathologic findings in a resected sigmoid colon and rectum // Gastroenterology. – 1987. – Vol. 93, N 6. – P. 1404–1408.Murray F.E., O’Brien M.J., Birkett D.H. et al. Diversion colitis. Pathologic findings in a resected sigmoid colon and rectum // Gastroenterology. – 1987. – Vol. 93, N 6. – P. 1404–1408.Neut C., Guillemot F., Colombel J.F. Nitrate-reducing bacteria in diversion colitis: a clue to inflammation // Dig. Dis. Sci. – 1997. – Vol. 42, N 12. – P. 2577–2580.Neut C., Guillemot F., Colombel J.F. Nitrate-reducing bacteria in diversion colitis: a clue to inflammation // Dig. Dis. Sci. – 1997. – Vol. 42, N 12. – P. 2577–2580.Nijhof H.W., Claassen A.T., Delemarre J.B. Colostomy as a cause of deveriation colitis in a blind- ended bowel segment // Ned. Tijdschr. Geneeskd. – 2006. – Vol. 11, N 150 (suppl. 10). – P. 559–562.Nijhof H.W., Claassen A.T., Delemarre J.B. Colostomy as a cause of deveriation colitis in a blind- ended bowel segment // Ned. Tijdschr. Geneeskd. – 2006. – Vol. 11, N 150 (suppl. 10). – P. 559–562.Ordein J.J., Di Lorenzo C., Flores A., Hyman P.E. Diversion colitis in children with severe gastrointestinal motility disorders // Am. J. Gastroenterol. – 1992. – Vol. 87, N 1. – P. 88–90.Ordein J.J., Di Lorenzo C., Flores A., Hyman P.E. Diversion colitis in children with severe gastrointestinal motility disorders // Am. J. Gastroenterol. – 1992. – Vol. 87, N 1. – P. 88–90.Orsay C.P., Kim D.O., Pearl R.K., Abcarian H. Diversion colitis in patient scheduled for coloctomy closure // Dis. Colon Rectum. – 1993. – Vol. 36, N 4. – P. 366–367.Orsay C.P., Kim D.O., Pearl R.K., Abcarian H. Diversion colitis in patient scheduled for coloctomy closure // Dis. Colon Rectum. – 1993. – Vol. 36, N 4. – P. 366–367.Roe A.M., Warren B.F., Brodribb A.J., Brown C. Diversion colitis and involution of the defunctioned anorectum // Gut. – 1993. – Vol. 34, N 3. – P. 382–385.Roe A.M., Warren B.F., Brodribb A.J., Brown C. Diversion colitis and involution of the defunctioned anorectum // Gut. – 1993. – Vol. 34, N 3. – P. 382–385.Roediger W.E.N. The starved colon diminished mucosal nutrition, diminished absorption, and colitis // Dis. Colon Rectum. – 1990. – Vol. 33. – P. 858–862.Roediger W.E.N. The starved colon diminished mucosal nutrition, diminished absorption, and colitis // Dis. Colon Rectum. – 1990. – Vol. 33. – P. 858–862.Toolenaar T.A., Freundt I., Huikeshoven F.J. et al. The occurrence of diversion colitis in patients with a sigmoid neovagina // Hum. Pathol. – 1993. – Vol. 24, N 8. – P. 846–849.Toolenaar T.A., Freundt I., Huikeshoven F.J. et al. The occurrence of diversion colitis in patients with a sigmoid neovagina // Hum. Pathol. – 1993. – Vol. 24, N 8. – P. 846–849.Warren B.F., Shepherd N.A., Bartolo D.C., Bradfield J.W. Pathology of the defunctioned rectum in ulcerative colitis // Gut. – 1993. – Vol. 34, N 4. – P. 514–516.Warren B.F., Shepherd N.A., Bartolo D.C., Bradfield J.W. Pathology of the defunctioned rectum in ulcerative colitis // Gut. – 1993. – Vol. 34, N 4. – P. 514–516.Whelan R.L., Abramson D., Kim D.S., Hashmi H.F. Diversion colitis. A prospective study // Surg. Endosc. – 1994. – Vol. 8, N 1. – P. 19–24.Whelan R.L., Abramson D., Kim D.S., Hashmi H.F. Diversion colitis. A prospective study // Surg. Endosc. – 1994. – Vol. 8, N 1. – P. 19–24.

The authors declare that there are no conflicts of interest present.