Stereological evaluation of ganglion cells in the sigmoid colon in primary and recurrent sigmoid volvulus
To clarify the role of ganglion cells in Auerbach’s plexus of the sigmoid colon in the development and recurrence of sigmoid volvulus (SV). Materials and methods: Pathological block samples of colonic resection materials of 28 patients who underwent sigmoidectomy for SV and, for comparison, samples of 28 patients who underwent sigmoidectomy or low anterior resection for rectosigmoid cancer (RSC) were analyzed using stereological methods. Results: The mean numerical density of ganglion cells was significantly lower in the SV group than in the RSC group (140.70 mm-2 and 669.42 mm-2, respectively, P = 0.005), whereas there was no significant difference between the revolvulus and nonrevolvulus SV groups (128.45 mm-2 and 185.67 mm-2, respectively, P > 0.05). Similarly, the mean numerical density of ganglion cells in elderly SV patients was found to be significantly lower than that in nonelderly SV patients (66.57 mm-2 and 214.86 mm-2, respectively, P = 0.002), while there was no significant difference between elderly and nonelderly RSC patients (638.60 mm-2 and 705.00 mm-2, respectively, P > 0.05). Conclusion: SV may be related to a decreased numerical density of ganglion cells in Auerbach's plexus, and the degenerative loss of ganglion cells due to advancing age is possible in elderly SV patients.
Stereological evaluation of ganglion cells in the sigmoid colon in primary and recurrent sigmoid volvulus
To clarify the role of ganglion cells in Auerbach’s plexus of the sigmoid colon in the development and recurrence of sigmoid volvulus (SV). Materials and methods: Pathological block samples of colonic resection materials of 28 patients who underwent sigmoidectomy for SV and, for comparison, samples of 28 patients who underwent sigmoidectomy or low anterior resection for rectosigmoid cancer (RSC) were analyzed using stereological methods. Results: The mean numerical density of ganglion cells was significantly lower in the SV group than in the RSC group (140.70 mm-2 and 669.42 mm-2, respectively, P = 0.005), whereas there was no significant difference between the revolvulus and nonrevolvulus SV groups (128.45 mm-2 and 185.67 mm-2, respectively, P > 0.05). Similarly, the mean numerical density of ganglion cells in elderly SV patients was found to be significantly lower than that in nonelderly SV patients (66.57 mm-2 and 214.86 mm-2, respectively, P = 0.002), while there was no significant difference between elderly and nonelderly RSC patients (638.60 mm-2 and 705.00 mm-2, respectively, P > 0.05). Conclusion: SV may be related to a decreased numerical density of ganglion cells in Auerbach's plexus, and the degenerative loss of ganglion cells due to advancing age is possible in elderly SV patients.
___
- Gundersen HJG, Jensen EB. The efficacy of systematic sampling in stereology and its prediction. J Microsc 1987; 147: 229–63.
- Gundersen HJG, Bagger P, Bendtsen TF, Evans SM, Korbo L, Marcussen N et al. The new stereological tools: disector, fractionator, nucleator and point sampled intercepts and their use in pathological research and diagnosis. APMIS 1988; 96: 857–81.
- Avots-Avotins KV, Waugh DE. Colon volvulus and geriatric patient. Surg Clin North Am 1982; 62: 248–60.
- Tan FLS, Tan YM, Heah SM, Seow-Choen F. Adult Hirschsprung’s disease presenting as sigmoid volvulus: a case report and review of literature. Tech Coloproctol 2006; 10: 245–8.
- Venugopal KS, Wilcox DT, Bruce J. Hirschsprung’s disease presenting as sigmoid volvulus in a newborn. Eur J Pediatr Surg 1997; 7: 172–3.
- Erdener A, Ulman I, Ozcan C, Genc K. A case of sigmoid volvulus secondary to Hirschsprung’s disease. Pediatr Surg Int 1995; 10: 409– 10.
- Ryan P. Sigmoid volvulus with and without megacolon. Dis Colon Rectum 1982; 25: 673–9.
- Harbrecht PJ, Fry DE. Recurrence of volvulus after sigmoidectomy. Dis Colon Rectum 1979; 22: 420–4.
- Morrissey TB, Deitch EA. Recurrence of sigmoid volvulus after surgical intervention. Am Surg 1994; 60: 329–31.
- Sonnenberg A, Tsou VT, Müller AD. The ‘institutional colon’: a frequent colonic dysmotility in psychiatric and neurologic disease. Am J Gastroenterol 1994; 89: 62–6.
- Chung YFA, Eu KW, Nyam DCNK, Leong AFPK, Ho YH, Seow- Choen F. Minimizing recurrence after sigmoid volvulus. Br J Surg 1999; 86: 231–3.
- Strom PR, Stone HH, Fabian TC. Colonic atony in association with sigmoid volvulus: its role in recurrence of obstructive symptoms. South Med J 1982; 75: 933–6.
- Atamanalp SS, Ozturk G. Sigmoid volvulus in the elderly: outcomes of a 43-year, 453-patient experience. Surg Today 2011; 41: 514–9.
- Cazador AC, Coll RF, Pujol FO, de Palol MP, Grillo AM, Romeu NG et al. Colonic volvulus and recurrence of volvulus: what should we do? Cirugia Espanola 2011; 89: 237–42.
- Barbosa AJ, Tafuri WL. Ganglion cell number in hypertrophic colon above experimental stenosis. Braz J Med Biol Res 1983; 16: 165–9.