Colonic Pseudo-obstruction With Transition Zone: A Peculiar Eastern Severe Dysmotility
- Author:
Eun Mi SONG
1
;
Jong Wook KIM
;
Sun Ho LEE
;
Kiju CHANG
;
Sung Wook HWANG
;
Sang Hyoung PARK
;
Dong Hoon YANG
;
Kee Wook JUNG
;
Byong Duk YE
;
Jeong Sik BYEON
;
Suk Kyun YANG
;
Hyo Jeong LEE
;
Chang Sik YU
;
Chan Wook KIM
;
Seong Ho PARK
;
Jihun KIM
;
Seung Jae MYUNG
Author Information
- Publication Type:Original Article
- Keywords: Colonic pseudo-obstruction; Intestinal pseudo-obstruction; Pathology; Outcomes
- MeSH: Cell Count; Colectomy; Colon; Colonic Pseudo-Obstruction; Cytomegalovirus Infections; Eosinophils; Follow-Up Studies; Ganglion Cysts; Humans; Intestinal Pseudo-Obstruction; Korea; Male; Myenteric Plexus; Pathology; Recurrence; Ulcer
- From:Journal of Neurogastroenterology and Motility 2019;25(1):137-147
- CountryRepublic of Korea
- Language:English
- 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.
