Chronic idiopathic intestinal pseudo-obstruction caused by acquired visceral neuropathy localised in the left colon: Report of two cases |
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Authors: | Hiroshi Suzuki MD Shinichi Amano Koichi Matsumoto Tatsushi Kitagawa Tohru Masuda |
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Institution: | (1) The Second Department of Surgery, Mie University School of Medicine, 2-174 Edobashi, 514 Tsu, Japan |
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Abstract: | Two cases of chronic idiopathic intestinal pseudo-obstruction (CIIP) are reported. One is a 51-year-old man, and the other
is a 47-year-old woman. Both patients presented with severe constipation and barium enema showed a marked dilation of the
right colon, and a narrowing in the left colon. Studies done on the motility of the colon and anorectum revealed normal resting
pressure profiles of the anorectom, a normal recto-anal reflex, and a normal resting tone of the collapsed colon. Administration
of methacholine chloride, however, provoked large, non-propulsive movements in the collapsed colon, which were inhibited by
the administration of atropin sulfate. Histologic examination disclosed a marked decrease in neurons and an increase of Schwann
cells in the myenteric plexus of the collapsed colon. CIIP due to acquired visceral neuropathy localised in the left colon,
was diagnosed as a result of manometric and histologic findings. One case was cured surgically, by a left hemi-colectomy,
and the other was cured medically using choline antagonists and laxatives. |
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Keywords: | chronic idiopathic intestinal pseudo-obstruction (CIIP) visceral neuropathy colonic motility |
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