Colonic Pseudo-obstruction With Transition Zone: A Peculiar Eastern Severe Dysmotility
송은미, 김정욱, 이선호, 장기주, 황성욱, 박상형, 양동훈, 정기욱, 예병덕, 변정식, 양석균, 이효정, 유창식, 김찬욱, 박성호, 김지헌, 명승재,
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송은미 ( Song Eun-Mi )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
김정욱 ( Kim Jong-Wook )
Inje University Ilsan Paik Hospital Department of Internal Medicine
이선호 ( Lee Sun-Ho )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
장기주 ( Chang Ki-Ju )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
황성욱 ( Hwang Sung-Wook )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
박상형 ( Park Sang-Hyoung )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
양동훈 ( Yang Dong-Hoon )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
정기욱 ( Jung Kee-Wook )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
예병덕 ( Ye Byong-Duk )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
변정식 ( Byeon Jeong-Sik )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
양석균 ( Yang Suk-Kyun )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
이효정 ( Lee Hyo-Jeong )
Asan Medical Center Health Screening and Promotion Center
유창식 ( Yu Chang-Sik )
University of Ulsan College of Medicine Asan Medical Center Department of Colon and Rectal Surgery
김찬욱 ( Kim Chan-Wook )
University of Ulsan College of Medicine Asan Medical Center Department of Colon and Rectal Surgery
박성호 ( Park Seong-Ho )
University of Ulsan College of Medicine Asan Medical Center Department of Radiology
김지헌 ( Kim Ji-Hun )
University of Ulsan College of Medicine Asan Medical Center Department of Pathology
명승재 ( Myung Seung-Jae )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
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.
키워드
Colonic pseudo-obstruction; Intestinal pseudo-obstruction; Pathology; Outcomes
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