LOSS OF GANGLION-CELLS AND MARKED ATTENUATION OF BOWEL WALL IN CECAL DILATATION

Cecal dilatation may be encountered in volvulus, distal colonic obstru ction, and colonic pseudo-obstruction, Our study attempts to determine whether the dilatation is related to loss of ganglion cells and bowel wall attenuation. The records and colonic pathology of 27 patients wh o had undergone resection of the right colon for obstruction at the Ve terans Affairs Medical Center, Buffalo, New York, were reviewed. Patie nts with severe ischemic changes and bowel wall necrosis were excluded , The remaining 10 cases were all elderly males who had cecal dilatati on associated with cecal volvulus (7 cases), distal obstruction (2 cas es), and colonic pseudo-obstruction (1 case). The dilated ceca ranged in circumference hom 12 to 35 cm with a wall thickness of 0.1 to 0.2 c m. Ganglion cells of the Auerbach's plexus were counted per 10 fields at 200x magnification in hematoxylin and eosin-stained sections. Adjac ent nondilated segments were examined for comparison. The number of ga nglion cells within the dilated segments was significantly lower (1 to 6 cells; mean of 2.8) than in adjacent nondilated segments (8 to 42; mean of 23). Both the muscularis mucosae and propria were markedly att enuated in the dilated segments, Since the parasympathetic tone is pro bably impaired given the loss of ganglion cells, it is conceivable tha t conservative measures alone may not provide long term relief from di latation. (C) 1996 Academic Press, Inc.