Colonic Pseudo-obstruction With Transition Zone: A peculiar eastern severe dysmotility

Eun Mi Song, 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

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3 Scopus citations

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.

Original languageEnglish
Pages (from-to)137-147
Number of pages11
JournalJournal of Neurogastroenterology and Motility
Volume25
Issue number1
DOIs
StatePublished - 1 Jan 2019

Keywords

  • Colonic pseudo-obstruction
  • Intestinal pseudo-obstruction
  • Outcomes
  • Pathology

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