J Neurogastroenterol Motil.  2019 Jan;25(1):137-147. 10.5056/jnm18121.

Colonic Pseudo-obstruction With Transition Zone: A Peculiar Eastern Severe Dysmotility

Affiliations
  • 1Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. sjmyung@amc.seoul.kr
  • 2Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-do, Korea.
  • 3Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea.
  • 4Department of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
  • 5Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
  • 6Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Jihunkim@amc.seoul.kr

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.

Keyword

Colonic pseudo-obstruction; Intestinal pseudo-obstruction; Pathology; Outcomes

MeSH Terms

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
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