Hand-assisted laparoscopic subtotal colectomy with cecorectal anastomosis for chronic idiopathic colonic pseudo-obstruction: report of a case

Miyazaki, Keiko; Torashima, Yasuhiro; Mochizuki, Seibu; Susumu, Seiya; Kanetaka, Kengo; Eguchi, Susumu; Kanematsu, Takashi; Abe, Kuniko; Fujita, Fumihiko

doi:10.1007/s00595-012-0430-3

Cited by 7 publications

(4 citation statements)

References 15 publications

(12 reference statements)

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“…The most effective surgical treatment for medically intractable constipation has been total colectomy with ileorectal anastomosis. 10,[12][13][14] In 5 patients (20 samples across different regions) where the specimens were prospectively collected over an approximately 5-year period, a series of morphological, functional and molecular studies were performed in addition to routine histopathology. Due to the infrequency of extreme cases that require surgery, colons from 8 patients (24 samples across different regions) were retrospectively studied, of which the histopathological and morphometric characteristics were assessed.…”

Section: Patientsmentioning

confidence: 99%

Molecular and Cellular Characteristics of the Colonic Pseudo-obstruction in Patients With Intractable Constipation

Suh

Myung

Kwak

et al. 2015

J Neurogastroenterol Motil

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Background/AimsChronic intestinal pseudo-obstruction (CIPO) is a disorder characterized by recurrent symptoms suggestive of obstruction such as abdominal pain, proximal distension with extremely suppressed motility in the absence of lumen-occluding lesion, whose etiology/pathophysiology is poorly understood. In this study we investigated a functionally obstructive lesion that could underlie symptoms of CIPO. MethodsWe studied colons surgically removed from 13 patients exhibiting clinical/pathological features of pseudo-obstruction but were unresponsive to standard medical treatments. The colons were characterized morphologically, functionally and molecularly, which were compared between regions and to 28 region-matched controls obtained from colon cancer patients. ResultsThe colons with pseudo-obstruction exhibited persistent luminal distension proximally, where the smooth muscle was hypertrophied with changes in the cell phenotypes. Distinct luminal narrowing was observed near the distal end of the dilated region, close to the splenic flexure, previously referred to as the "transition zone (TZ)" between the dilated and non-dilated loops. Circular muscles from the TZ responded less to depolarization and cholinergic stimulation, which was associated with downregulation of L-type calcium channel expression. Smooth muscle contractile protein was also downregulated. Myenteric ganglia and neuronal nitric oxide synthase (nNOS) positive cells were deficient, more severely in the TZ region. Interstitial cells of Cajal was relatively less affected. 561 ConclusionsThe TZ may be the principal site of functional obstruction, leading to proximal distension and smooth muscle hypertrophy, in which partial nNOS depletion could play a key role. The neuromuscular abnormalities probably synergistically contributed to the extremely suppressed motility observed in the colonic pseudo-obstruction.(J Neurogastroenterol Motil 2015;21:560-570)

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Section: Patientsmentioning

confidence: 99%

Molecular and Cellular Characteristics of the Colonic Pseudo-obstruction in Patients With Intractable Constipation

Suh

Myung

Kwak

et al. 2015

J Neurogastroenterol Motil

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“…In the case of segmental colectomy, it is possible that symptoms may recur with time, even if they initially improved after surgery. There are some reports of patients that required additional resection years after initial segmental colectomy [ 9 – 11 ]. The reasons included megacolon of unknown cause or ischemic necrosis due to sigmoid colon volvulus.…”

Section: Discussionmentioning

confidence: 99%

“…Decompression of the dilated colon by evacuating gas or stool from the stump of the appendix [ 10 ] or transanal drain [ 15 ] may improve visibility. In addition, it is possible to secure the operative field using hand-assisted laparoscopic surgery (HALS) if it is difficult to hold down or pull the dilated colon, especially at the splenic flexure [ 9 , 16 ]. However, reports do not mention the performance of colonoscopy as preparation on the day before surgery, as in our case.…”

Section: Discussionmentioning

confidence: 99%

Successful surgical procedure based on careful preoperative imaging for chronic idiopathic colonic pseudo-obstruction: a case report

et al. 2020

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Background Chronic idiopathic colonic pseudo-obstruction (CICP) is a rare disease, defined as a condition of the chronically damaged colon, without obstruction or stenosis, and a pathological abnormality in the myenteric plexus. To date, there is no effective medication for CICP, and existing medication is not useful, making surgery the only effective treatment. Laparoscopic surgery is useful for reducing surgical trauma and postoperative adhesion. Herein, we report a patient with recurrent laxative-uncontrolled bowel obstruction, who underwent successful treatment with laparoscopic total colectomy based on preoperative detailed evaluation of bowel function. Case presentation A 77-year-old female patient without any past abdominal or psychological medical history was referred to our hospital because of chronic constipation and abdominal pain. Contrast-enhanced computed tomography, barium enema, cine magnetic resonance imaging, and defecography indicated an enlarged colon from the cecum to the transverse colon (proximal to the splenic flexure) without apparent mechanical obstruction, and a collapsed colon from the descending colon to the rectum, with reduced peristalsis. Bowel movements of the rectum and anorectal function were normal. Based on these findings, we diagnosed CICP and performed laparoscopic total colectomy and ileo-rectal anastomosis in this case. Postoperative recovery was good, without the need for postoperative laxatives. Pathologically, no degeneration of the muscle layers or Auerbach’s plexus was found in the resected specimen. Conclusion Surgery is the only effective treatment for patients with CICP. Careful imaging before surgery is important for detecting the extent of excision required. This will reduce the need for additional surgery due to symptom relapse in the remnant colon. However, continued observation of the patient is required.

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“…Miyazaki et al reported a case of colonic‐type CIIP corrected by hand‐assisted laparoscopic subtotal colectomy . They used the hand‐assisted technique because they believed that the colon was markedly distended and that the surgical space would be difficult to secure for total laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic subtotal colectomy for a patient with chronic idiopathic colonic pseudo‐obstruction: Report of a case

Ozawa

Ishihara

Okada

et al. 2019

Asian J Endoscop Surgery

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A 47‐year‐old male patient without a documented past medical history was referred to Sanno Hospital because of constipation and abdominal pain, which he had had for more than 5 years. Abdominal X‐ray and CT scan showed an enlarged ascending colon from the cecum to the transverse colon, without apparent mechanical obstruction. The patient was diagnosed with chronic idiopathic colonic pseudo‐obstruction, and because his symptoms were resistant to medication, surgical treatment was required. Laparoscopic subtotal colectomy was performed without any complications. Constipation was relieved, and the patient began defecating 2–3 times a day without medication. Pathological specimens showed that Meissner's plexus and Auerbach's plexus had decreased and that there were fewer ganglion cells—findings consistent with chronic idiopathic intestinal pseudo‐obstruction.

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Hand-assisted laparoscopic subtotal colectomy with cecorectal anastomosis for chronic idiopathic colonic pseudo-obstruction: report of a case

Cited by 7 publications

References 15 publications

Molecular and Cellular Characteristics of the Colonic Pseudo-obstruction in Patients With Intractable Constipation

Molecular and Cellular Characteristics of the Colonic Pseudo-obstruction in Patients With Intractable Constipation

Successful surgical procedure based on careful preoperative imaging for chronic idiopathic colonic pseudo-obstruction: a case report

Laparoscopic subtotal colectomy for a patient with chronic idiopathic colonic pseudo‐obstruction: Report of a case

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