Morphologic pattern of myenteric neural plexus in colonic diverticular disease. A whole-mount study employing histochemical staining for acetylcholinesterase.

BACKGROUND: Diverticular disease (DD) of the colon is a frequent clinical problem because 30-50% of the population over the age of 60 years in western communities are affected by DD. Although certain clinical, physiological and biochemical studies have shown that the origin of DD may be neurogenic, the mechanism of DD pathogenesis is still not clear.
METHODS: The aim of the present study has been to assess the morphologic pattern of the myenteric nerve plexus (MNP) in diverticulous sigmoid colon (DSC) comparing the structural organization in DSC (n=10) to relatively normal sigmoid colon (rNSC) that had been resected from patients for rectal tumors (n=10). The histochemical method for acetylcholinesterase was utilized to visualize the MNP on pressure bloated, non-sectioned gut preparations.
RESULTS: The study revealed that the MNP of DSC was degenerated, as its interganglionic nerves were periodically interrupted and thinner than in rNSC. The number of myenteric ganglia in same-sized areas (125 mm(2)) as well as the average area of myenteric plexus was significantly higher in controls compared with the DD patients, (respectively, ganglion number: 163 +/- 12 and 149 +/- 12, p<0.02; MN-plexal area: 8.1 +/- 0.3 mm(2) and 7.2 +/- 0.2 mm(2), p<0.001).
CONCLUSION: The occurrence of DD in sigmoid colon is associated with morphologic alterations in MNP (i.e. the number of ganglia and plexus rarefaction, ganglion size and plexal area involution), which presumably demonstrate the failure of MNP in DD patients.