Myenteric plexitis: A frequent feature in patients undergoing surgery for colonic diverticular disease

Abstract

Background: Diverticular disease of the colon is frequent in clinical practice, and a large number of patients each year undergo surgical procedures worldwide for their symptoms. Thus, there is a need for better knowledge of the basic pathophysiologic mechanisms of this disease entity. Objectives: Because patients with colonic diverticular disease have been shown to display abnormalities of the enteric nervous system, we assessed the frequency of myenteric plexitis (i.e. the infiltration of myenteric ganglions by inflammatory cells) in patients undergoing surgery for this condition. Methods: We analyzed archival resection samples from the proximal resection margins of 165 patients undergoing left hemicolectomy (60 emergency and 105 elective surgeries) for colonic diverticulitis, by histology and immunochemistry. Results: Overall, plexitis was present in almost 40% of patients. It was subdivided into an eosinophilic (48%) and a lymphocytic (52%) subtype. Plexitis was more frequent in younger patients; and it was more frequent in those undergoing emergency surgery (50%), compared to elective (28%) surgery (p ¼ 0.007). All the severe cases of plexitis displayed the lymphocytic subtype. Conclusions: In conclusion, myenteric plexitis is frequent in patients with colonic diverticular disease needing surgery, and it might be implicated in the pathogenesis of the disease.

Myotonic dystrophy type 1 and pseudo-obstruction in a child with smooth muscle α-actin deficiency and eosinophilic myenteric plexitis

“…Plexitis was graded as mild (presence of ≤4 eosinophils penetrating, apportioned to, or within an enteric ganglion) according to previously published criteria (4). No additional feature of plexitis (lymphocytic infiltration) and of smooth muscle degeneration, such as fibrosis or vacuolization, was present.…”

Italian nationwide survey of pharmacologic treatments in diverticular disease: Results from the REMAD registry

“…The approaches generally proposed in clinical practices include a high‐fibre diet, the use of anti‐spasmodics, mesalazine, cyclic poorly absorbable antibiotics such as rifaximin, prebiotics and probiotics 8 , 9 , 20 . The rationale for the use of anti‐inflammatory therapies or approaches targeting enteric bacteria is based on pathophysiological studies showing low‐grade inflammation, 21 , 22 and on the hypothesis that bacterial overgrowth in the diverticulum is the initiator of events evolving into symptom generation, inflammation and complications 23 . We have recently shown the presence of dysbiosis involving pro‐inflammatory and pathogenetic bacteria in patients with SUDD.…”

State-of-the-art surgery for sigmoid diverticulitis

“…12 ) [ 90 ]. The IMA-preserving technique is performed by ligating the sigmoid vessels close to the colon, but this manoeuvre can be challenging due to mesosigmoid fibrosis commonly associated with the inflammation of the myoenteric plexus (40%) [ 91 ]. For this reason, the skeletonization of the sigmoid mesentery close to the bowel wall might be safer with the use of “cut and tie” devices [ 92 ].…”