Loss of ganglion cells and marked attenuation of bowel wall in cecal dilatation.

Cecal dilatation may be encountered in volvulus, distal colonic obstruction, and colonic pseudo-obstruction. Our study attempts to determine whether the dilatation is related to loss of ganglion cells and bowel wall attenuation. The records and colonic pathology of 27 patients who had undergone resection of the right colon for obstruction at the Veterans Affairs Medical Center, Buffalo, New York, were reviewed. Patients with severe ischemic changes and bowel wall necrosis were excluded. The remaining 10 cases were all elderly males who had cecal dilatation associated with cecal volvulus (7 cases), distal obstruction (2 cases), and colonic pseudo-obstruction (1 case). The dilated ceca ranged in circumference from 12 to 35 cm with a wall thickness of 0.1 to 0.2 cm. Ganglion cells of the Auerbach's plexus were counted per 10 fields at 200x magnification in hematoxylin and eosin-stained sections. Adjacent nondilated segments were examined for comparison. The number of ganglion cells within the dilated segments was significantly lower (1 to 6 cells; mean of 2.8) than in adjacent nondilated segments (8 to 42; mean of 23). Both the muscularis mucosae and propria were markedly attenuated in the dilated segments. Since the parasympathetic tone is probably impaired given the loss of ganglion cells, it is conceivable that conservative measures alone may not provide long term relief from dilatation.