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Revista do Colégio Brasileiro de Cirurgiões

Print version ISSN 0100-6991

Rev. Col. Bras. Cir. vol.26 no.3 Rio de Janeiro May/June 1999

http://dx.doi.org/10.1590/S0100-69911999000300012 

ARTIGO DE ATUALIZAÇÃO

 

Colite de derivação fecal

 

Diversion colitis

 

 

Francisco Edilson Leite Pinto Júnior, ACBC-RNI; Ariano José Freitas de Oliveira, RCBC-RNII; Kallyandre Ferreira de MedeirosII; Ana Maria de Oliveira RamosIII; Aldo da Cunha Medeiros, TCBC-RNIV

IProfessor Assistente I da Disciplina de Técnica Operatória - Cirurgia Experimental. Coordenador da Residência Médica em Cirurgia Geral da UFRN. Mestre pela UFPE
IIResidente de Cirurgia Geral da UFRN
IIIProfessora de Patologia da UFRN
IVDoutor em Cirurgia. Professor Adjunto IV e Chefe da Disciplina de Técnica Operatória e Cirurgia Experimental da UFRN. Pesquisador 1b do CNPq

Endereço para correspondência

 

 


RESUMO

A colite de derivação fecal (CD) é um processo inflamatório que ocorre no segmento colorretal desfuncionalizado, após uma cirurgia de desvio do trânsito intestinal. As principais características dessa entidade clínica são: apresenta-se na desfuncionalização do cólon ou reto; não há doença inflamatória intestinal preexistente; nunca acomete o sítio proximal à colostomia e ocorre resolução do processo após a restauração do trânsito intestinal. Diversas são as hipóteses postuladas para explicar o seu aparecimento; todavia, a deficiência nutricional do epitélio colônico, pela ausência dos ácidos graxos de cadeia curta (AGCC), no segmento desfuncionalizado, é a mais aceita na atualidade. Os autores fazem uma revisão da literatura enfocando os aspectos clínicos, histopatológicos e terapêuticos desta doença.

Unitermos: Colite de derivação; Ácidos graxos de cadeia curta; Mucosa intestinal; Colostomia.


 ABSTRACT

The authors present a revision of diversion colitis. It is an inflammatory disorder that occurs in the colorectum segment after a diverting colostomy. The main features of this disease are: colon or rectum disfunction; no previous intestinal inflammatory disorder; it never attacks the colon upper colostomy; after intestinal transit restoration, the inflammatory process is solved. Many hypothesis are postulated to explain its occurrance. They include: fecal stasis; changes in the bacterial population of colon; nutritional deficiency of colonic epithelium due to the absence of short chain fatty acids in the defunctionalized segment is the most accepted nowadays. The absence of fatty acids produces energetic defficiency in colon mucosa, reduced electrolite absorption and secretion, and reduced mucus production. The patients have abdominal pain, mucus diarrhoea and bleeding. Histopathological features include chronical inflamation of colon wall, vascular congestion and changes in mucosa cripts. Lynphoid hiperplasy of mucosa and submucosa are common. The diagnosis is done by endoscopy, radiology, pathology and laboratory data. Surgery is considered the best treatment and when the intestinal continuity is restored the patients get cured. The topical use of short chain fatty acids by enema have had good results in some cases. As diversion colitis results in many assimptomatic patients, its incidence is understimated and more attention is needed always when a colostomy is done.

Key words: Derivation colitis; Short-chain fatty acids; Intestinal mucosa.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

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Endereço para correspondência:
Dr. Francisco Edilson Leite Pinto Júnior
Av. Brigadeiro Gomes Ribeiro, 1025
59056-520 - Natal-RN
E-mail: edilsonpinto@uol.com.br

Recebido em 23/11/98
Aceito para pub1icaçãob em 19/4/99

 

 

Trabalho realizado no Departamento de Cirurgia da Universidade Federal do Rio Grande do Norte - UFRN.

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