Segmental muscular defects of the intestine: a possible cause of spontaneous perforation of the bowel in adults
Segmental muscular defects of the intestine: a possible cause of spontaneous perforation of the bowel in adults
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DOI：
10.1016/j.humpath.2013.07.004
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发表时间：
2013-12-01
期刊：
影响因子：
3.3
通讯作者：
Tsujimoto, Akio
中科院分区：
文献类型：
--
作者：
Tamai, Masamitsu;Satoh, Michiko;Tsujimoto, Akio
特发性肠穿孔被描述为自发性肠穿孔;只有少数情况下，已报告的成人。我们对7例成人自发性肠穿孔病例进行了组织学分析（患者平均年龄为63.3 [范围：44-89]岁;男女比例为1：1.3），发现了一些以前未报道的结果。所有患者均无先天性疾病。所有患者均表现为急腹症，剖腹探查时发现肠穿孔。穿孔，直径范围从针尖大小到3厘米，分别在4例和3例结肠和小肠发展。1例患者有2处穿孔。组织学检查显示穿孔部位周围有节段性固有肌层缺损。肌肉缺损的范围和程度因病例而异;然而，所有病变均包括全层肌肉缺损。未观察到与缺损相关的显著炎性细胞浸润。除1例出血外，粘膜及粘膜肌层均保持正常。未发现肉芽组织等修复性变化;然而，在破裂的固有肌层边缘偶尔可见短梭形细胞或成纤维细胞增殖。在1例病例中，在远离穿孔部位的区域也观察到肌肉缺损。这些发现与新生儿小肠自发性穿孔非常相似。成人节段性肌肉缺损的病因尚不清楚。可能是局灶性先天性异常。在任何情况下，节段性肌肉缺损可以解释肠壁弱化，并且它可以是成人肠自发性穿孔的主要原因。(C)2013 Elsevier Inc. All rights reserved.
Idiopathic intestinal perforation has been described as spontaneous bowel perforation; only a few cases of the condition have been reported in adults. We conducted a histologic analysis of 7 adult cases of spontaneous intestinal perforation (mean patient age, 63.3 [range, 44-89] years; male-to-female ratio, 1:1.3), which revealed some previously unreported findings. None of the patients had congenital disease. All patients presented with acute abdomen, and intestinal perforations were detected during laparotomy. Perforations, ranging in diameter from a pinpoint size to 3 cm, developed in the colon and small bowel in 4 and 3 cases, respectively. One patient had 2 perforations. Histologic examinations revealed segmental muscularis propria defects around the perforation sites. The extent and degree of the muscular defect varied from case to case; however, all lesions included full-thickness muscular defects. No significant infiltration of inflammatory cells was observed associated with the defects. The mucosa and muscularis mucosa were maintained normally, except in 1 hemorrhagic case. Reparative changes such as granulation were not found; however, short spindle cells or fibroblasts occasionally proliferated around the edges of the disrupted muscularis propria. In 1 case, a muscular defect was also observed in an area far from the perforation site. These findings closely resemble those of neonatal intestine with spontaneous perforation. Etiology of segmental muscular defects in adults is unclear. It may be focal congenital anomaly. In any case, the segmental muscular defects can explain bowel wall weakening, and it can be a major cause of spontaneous perforation of the adult bowel. (C) 2013 Elsevier Inc. All rights reserved.