Dwd. Collure et Hr. Hameer, LOSS OF GANGLION-CELLS AND MARKED ATTENUATION OF BOWEL WALL IN CECAL DILATATION, The Journal of surgical research, 60(2), 1996, pp. 385-388
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.