DESMOSIS OF THE COLON - A WORKING HYPOTHESIS OF PRIMARY CHRONIC CONSTIPATION

Introduction: Over the last few years, resected specimens of colon fro m children and young adults have been systematically studied with rega rd to the vegetative innervation of the colon and its net of stabilizi ng connective tissue in the muscularis propria, From the basic investi gations of Goerttler, it is known that this connective tissue net has important functions in the coordinated movement of longitudinal and ci rcular muscles. The present study reports on cases of chronic constipa tion, which showed in most cases histopathologically a normal number o f nerve cells and ganglia in the myenteric plexus, but abnormalities i n the connective tissue net (desmosis). Subjects and methods: Over 6 y ears, 236 cases (12+/-8 years of age), which were treated surgically f or an aganglionosis, hypoganglionosis, hypoperistalsis syndrome and me gacolon development, were histopathologically investigated. All surgic al specimens were native, caudo-cranially coiled, and were cut 15 mu m (equiv. to 4-5 mu m paraffin sections) by a cryostat. The vegetative nervous system of the gut was stained with acetylcholinesterase and de hydrogenase reactions. The tissue was also fixed in formalin, embedded in paraffin, and 4 mu m sections were stained with hematoxylineosin a nd picric acid/sirius red. Collagen III; S 100 and PCP 9.5 immunohisto chemical reactions were performed, Results: 14 surgical specimens (6%) showed total or focal lack of the connective tissue net in the vicini ty of the myenteric plexus. Between the connective tissue net of circu lar and longitudinal muscles, a continuous connection was missing. The se cases were mainly characterized by a hypoperistalsis syndrome or a megacolon without any anomaly of the vegetative innervation, 222 cases (94%) were treated for Hirschsprung's disease or hypoganglionosis wit hout any anomaly of the connective tissue of the muscularis propria. C onclusion: The missing continuity of the connective tissue net in the muscularis propria seems to abolish coordinated alternative movement o f circular and longitudinal muscles. Therefore, the lack of coordinate d propulsive activity of the colon results in a therapy-resistant chro nic constipation, with a hypoperistalsis syndrome.