Colonic Pseudo-obstruction With Transition Zone: A Peculiar Eastern Severe Dysmotility
Journal of Neurogastroenterology and Motility
;
: 137-147, 2019.
Article
in English
| WPRIM
| ID: wpr-740765
ABSTRACT
BACKGROUND/AIMS:
Previous studies from Korea have described chronic intestinal pseudo-obstruction (CIPO) patients with transition zone (TZ) in the colon. In this study, we evaluated the pathological characteristics and their association with long-term outcomes in Korean colonic pseudo-obstruction (CPO) patients with TZ.METHODS:
We enrolled 39 CPO patients who were refractory to medical treatment and underwent colectomy between November 1989 and April 2016 (median age at symptoms onset 45 [interquartile range, 29–57] years, males 46.2%). The TZ was defined as a colonic segment connecting a proximally dilated and distally non-dilated segment. Detailed pathologic analysis was performed.RESULTS:
Among the 39 patients, 37 (94.9%) presented with TZ and 2 (5.1%) showed no definitive TZ. Median ganglion cell density in the TZ adjusted for the colonic circumference was significantly decreased compared to that in proximal dilated and distal non-dilated segments in TZ (+) patients (9.2 vs 254.3 and 150.5, P < 0.001). Among the TZ (+) patients, 6 showed additional pathologic findings including eosinophilic ganglionitis (n = 2), ulcers with combined cytomegalovirus infection (n = 2), diffuse ischemic changes (n = 1), and heterotropic myenteric plexus (n = 1). During follow-up (median, 61 months), 32 (82.1%) TZ (+) patients recovered without symptom recurrence after surgery. The presence of pathological features other than hypoganglionosis was an independent predictor of symptom recurrence after surgery (P = 0.046).CONCLUSIONS:
Hypoganglionosis can be identified in the TZ of most Korean CPO patients. Detection of other pathological features in addition to TZ-associated hypoganglionosis was associated with poor post-operative outcomes.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Pathology
/
Recurrence
/
Ulcer
/
Colonic Pseudo-Obstruction
/
Intestinal Pseudo-Obstruction
/
Cell Count
/
Follow-Up Studies
/
Colectomy
/
Colon
/
Cytomegalovirus Infections
Type of study:
Observational study
/
Prognostic study
/
Risk factors
Limits:
Humans
/
Male
Country/Region as subject:
Asia
Language:
English
Journal:
Journal of Neurogastroenterology and Motility
Year:
2019
Type:
Article
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