Gabrio Bassotti1, Vincenzo Villanacci2, Angelo Sidoni3, Riccardo Nascimbeni4, Maria P Dore5, Gian A Binda6, Roberto Bandelloni7, Marianna Salemme2, Rachele Del Sordo3, Moris Cadei2, Alessandra Manca8, Nunzia Bernardini9, Christoph A Maurer10, Gieri Cathomas10. 1. Department of Medicine, University of Perugia School of Medicine, Perugia, Italy. 2. Pathology Institute, Spedali Civili, Brescia, Italy. 3. Department of Experimental Medicine, University of Perugia School of Medicine, Perugia, Italy. 4. Department of Medical and Surgical Sciences, University of Brescia School of Medicine, Brescia, Italy. 5. Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy ; Baylor College of Medicine, Houston, TX, USA. 6. Department of General Surgery, Galliera Hospital, Genova, Italy. 7. Department of Pathology, Galliera Hospital, Genova, Italy. 8. Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy. 9. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 10. Hospital of Baselland, University of Basel, Liestal, Switzerland.
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 = 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.
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 = 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.
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