Nonspecific colitis of the excluded colonic segment
Diversion colitis is an inflammatory process occurring in an empty colon or rectum after surgical diversion of the fecal stream. It was first recognized in patients with chronic inflammatory bowel disease (IBD). It is still more common in these patients, although it has been reported with other, non-inflammatory conditions. Most patients have mild to moderate symptoms, typically tenesmus and diarrhea which may be mucous or bloody. Rare cases present with fulminant colitis. It is commonly believed that diversion colitis starts in the mucosa, with damage to the colonic epithelium. The colonocytes use mainly luminal short-chain fatty acids (SCFAs) as nutrients. SCFAs are metabolites of carbohydrate and peptide fermentation by obligate anaerobic bacteria. The number of these bacteria is reduced in an excluded colon.
The incidence and prevalence of this disease are difficult to estimate since...