Traumatic constipation

Devroede, Ghislain; Arhan, Pierre; Duguay, Colette; Tétreault, L; Akoury, Hani; Perey, Bernard

doi:10.1016/0016-5085(79)90166-5

Cited by 67 publications

(17 citation statements)

References 12 publications

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“…First, in analogy with two studies that investigated the effect of spinal cord and (parasympathetic) peripheral nerve lesions on the ENS, we did find loss of ganglion cells in the myenteric plexus of the colon. However, the submucosal plexus was considered to be normal [21, 31], which we confirmed in our study. Upon analysis of subsets of neurons, we observed loss of calretinin-positive neurons in the patient groups.…”

Section: Discussionsupporting

confidence: 85%

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The enteric nervous system and the musculature of the colon are altered in patients with spina bifida and spinal cord injury

et al. 2017

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Neurogenic bowel dysfunction occurs in a large percentage of adult patients with spina bifida (SB) and spinal cord injury (SCI), significantly affecting their quality of life. Although bowel motility is autonomously regulated by the enteric nervous system (ENS), disruption of the modulation of the ENS by extrinsic innervation as present in many patients with SB and SCI might lead to motility disorders. In order to gain insight in the pathophysiology, we studied histological changes of the neuromuscular structures in the colon of SB and SCI patients. Archival colon tissue blocks from SB (n = 13) and SCI (n = 34) patients were collected nationwide in The Netherlands and compared with control samples (n = 16). Histological (semiquantitative) evaluation of the ENS, the network of interstitial cells of Cajal (ICC), and the muscularis propria was performed using hematoxylin and eosin, periodic acid Schiff, and elastic von Gieson staining, and immunohistochemistry with antibodies against HuC/D, calretinin, S100, CD117, α-smooth muscle actin, and desmin. Compared to controls, SB and SCI patients showed neuronal loss and decreased nerve fiber density in the myenteric plexus. Lower nerve fiber density was significantly more often found in patients with severe bowel dysfunction. Other major findings were loss of ICCs around the myenteric plexus and fibrosis in the longitudinal muscle layer. Altered histology of the ENS may explain abnormal intestinal motility in SB and SCI patients. Furthermore, loss of myenteric nerve fibers (including enteric glial cells) may play a major role in the development of severe motility complaints.Electronic supplementary materialThe online version of this article (doi:10.1007/s00428-016-2060-4) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 85%

“…This is supported by a study in rats with myelomeningocele, suggesting that the anorectal unit is normally developed [41]. This has led to the hypothesis that loss of extrinsic innervation may result in trans-neuronal degeneration, although the exact mechanism in the bowel is currently unknown [21, 31]. …”

Section: Discussionmentioning

confidence: 87%

The enteric nervous system and the musculature of the colon are altered in patients with spina bifida and spinal cord injury

et al. 2017

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“…32 In a previous study, we demonstrated that delayed CTT is a key constipation mechanism in patients with motor complete SCI without SSRs 14 and that delayed CTT is less frequent when SSRs are preserved. In the present study, we found that, as in patients with motor incomplete lesions, a delayed CTT is present in the same proportion of patients with motor complete lesions with SSRs.…”

Section: Discussionmentioning

confidence: 99%

Pathophysiology of Bowel Dysfunction in Patients with Motor Incomplete Spinal Cord Injury: Comparison with Patients with Motor Complete Spinal Cord Injury

Vallès

Mearin

2009

Diseases of the Colon &Amp; Rectum

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Many severe pathophysiologic mechanisms are involved in neurogenic bowel, affecting patients with motor incomplete spinal cord injury similarly to those of patients with motor complete lesions with spinal sacral reflexes. The pathophysiologic mechanisms of constipation are obstructed defecation, weak abdominal muscles, impaired rectal sensation, and delayed colonic transit time; the mechanisms of fecal incontinence are impaired external anal sphincter contraction, uninhibited rectal contractions, and impaired rectal sensation. However, specific evaluation is required in individual cases.

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“…The tests involving inhaled ipratropium provide evidence in support of the sensitivity of rectal flow as a measure of the cholinergic drive. There is a positive cholinergic sacral efferent drive, not just to motor function,28 29 but also to blood flow. In constipation, especially slow transit, there may already be some diminution in sacral activity, or there is less susceptibility to the inhalers, as evidenced by the lesser blood flow response to cholinergic blockade.…”

Section: Discussionmentioning

confidence: 99%

Laser Doppler flowmetry as a measure of extrinsic colonic innervation in functional bowel disease

Emmanuel

Kamm²

2000

Gut

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Background-In functional disorders it is unknown whether disturbed function is due to an intrinsic gut abnormality or altered extrinsic innervation. Aims-To study whether measurement of mucosal blood flow could be used as a quantitative direct measure of gut extrinsic nerve autonomic activity in patients with idiopathic constipation. Methods-Seventy two patients with idiopathic constipation and 26 healthy volunteers had rectal mucosal blood flow measurements by a laser Doppler flowmetry probe applied 10 cm from the anus. Measurements were made at rest and after inhaled placebo and ipratropium 40 µg. Results-Constipated subjects had lower baseline rectal blood flow than controls. Patients with slow transit had lower mucosal blood flow than normal transit. The number of retained markers on x ray was inversely correlated with blood flow. Ipratropium reduced blood flow compared with placebo, reduced it less in constipated patients than controls, and reduced it less in patients with slow compared with normal transit. Constipated patients, not controls, showed a significantly attenuated RR interval (the interval between successive R waves on the ECG) variability, and blood flow correlated with vagal function. Conclusions-Laser Doppler mucosal flowmetry is a gut specific, quantitative measure of extrinsic autonomic nerve activity. The technique has shown that patients with idiopathic constipation have impaired extrinsic gut nerve activity, and this is more notable in those with slow transit. The degree of slow transit correlates with the degree of impaired extrinsic innervation. (Gut 2000;46:212-217)

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Traumatic constipation

Cited by 67 publications

References 12 publications

The enteric nervous system and the musculature of the colon are altered in patients with spina bifida and spinal cord injury

The enteric nervous system and the musculature of the colon are altered in patients with spina bifida and spinal cord injury

Pathophysiology of Bowel Dysfunction in Patients with Motor Incomplete Spinal Cord Injury: Comparison with Patients with Motor Complete Spinal Cord Injury

Laser Doppler flowmetry as a measure of extrinsic colonic innervation in functional bowel disease

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