PULMONARY HETEROPLASIA IN THE TERMINAL ILEUM

Enteric nervous system, interstitial cells of cajal, and smooth muscle vacuolization in segmental dilatation of jejunum

BACKGROUND/PURPOSE

The etiology of congenital segmental dilatation (CSD) of bowel remains elusive. Intestitial cell of Cajal plays a role in the pace making of the intestine. Its abnormality has been documented in a variety of conditions of abnormal intestinal motility. The current study attempts to evaluate the roles of intestitial cells of Cajal, enteric nervous system, and smooth muscle in segmental dilatation of small bowel.

METHODS

Resected specimen from a neonate with segmental dilatation of jejunum was stained with H&E, Alcian blue, Periodic Acid-Schiff (PAS), and immunostained with S100, Ret, MAP5, and c-kit antibodies using the standard immunohistochemical process.

RESULTS

The immunostaining of S100, Ret, MAP5 and c-kit of CSD specimen were positive. Localized vacuolization was, however, detected in the circular smooth muscle of the jejunum. The Alcian blue and PAS staining of the vacuolization were negative.

CONCLUSIONS

CSD shows no abnormality in the enteric nervous system and pace makers. Localized vacuolization suggests myopathy to be a contributing factor to the disease. J Pediatr Surg 36:930-935.

Antenatal finding of intestinal obstruction caused by isolated segmental jejunal dilatation: a case report

The authors report a case of segmental jejunal dilatation that was discovered antenatally and manifested clinically as lower obstruction in a newborn boy. The antenatal ultrasound findings at 29, 30, and 31 weeks' gestation showed a constant hypoechogenic image (6 x 3 cm in diameter) localized to the right flank of the fetal abdomen, thought to be situated in the right colon. A prenatal diagnosis of incomplete right colonic stenosis was considered. In the immediate postnatal period, there were clinical manifestations of intestinal obstruction; however, results of a contrast enema and rectal biopsies were normal. An upper gastrointestinal contrast study showed a dilated jejunal loop situated approximately 15 cm from the ligament of Treitz. During surgery, a large dilated jejunal loop (7 cm in diameter, 15 cm in length) was found and resected. Histopathologic examination confirmed the diagnosis of segmental jejunal dilatation. This is the first antenatal illustration of this rare pathology, and it supports the hypothesis of a congenital origin for this anomaly.

Segmental dilatation of the ileum: an uncommon cause of neonatal intestinal obstruction

Two cases of congenital segmental dilatation of the ileum are reported. In both cases additional abnormal segments of bowel were not diagnosed during the initial laparotomy, and further surgical exploration was required. Consideration of this entity in the differential diagnosis of neonatal intestinal obstruction may enable definition of the optimal site for bowel resection and anastomosis.

Segmental dilatation of the colon. Report of a case and review of the literature

A case of segmental dilatation of the colon involving the rectosigmoid area is presented and added to 11 cases of segmental dilatation of the colon reported previously in the literature. The clinicopathologic features, etiology, and management are discussed.

Segmental dilatation of the duodenum

In this article two cases of idiopathic duodenal dilation are described. These cases meet the present criteria for segmental dilations of the intestine. The onset of the clinical features was acute in one case and chronic in the other. However, the radiological images were similar in both cases and provided the diagnosis. Surgical treatment consisted of duodenal resection and tapering and was curative in one case. The other patient died shortly after surgery. The duodenal specimens showed normal three-layer duodenal architecture in the pathology study. The intramural nervous plexi were unimpaired. Angiodysplasia was found in one case. Vascular abnormalities were also found in 10 other segmentary intestinal dilatations reported in the literature. The surgical implications of this new localization of segmentary intestinal dilatation are analyzed.

[Formal genesis of segmental intestinal dilatation]

The rare SDI leads to functional obstruction without stenosis and with regular functioning ganglionic cells. Up to day there was no theory of this congenital malformation in respect to formal and causal pathogenesis. Following our hypothesis, SDI is caused by a disturbance splitting the notochord from the entoderma. So in formal genesis SDI is seen as a part of a common complex consisting of SDI, congenital diverticulas and duplications of the intestine.

Case report: segmental dilatation of the ileum presenting with anaemia

A case of segmental dilatation of the ileum with an associated Meckel's diverticulum is reported in an 8-year-old child with anaemia. The pre-operative demonstration of this association has not previously been described in the literature.

Ileal dysgenesis in infants and children

Ileal dysgenesis describes the segmental dilatation of the terminal ileum treated in seven patients presenting from birth to 15 yr. Manifestations included saccular segmental ileal dilatation adherent to the peritoneal surface of an omphalocele sac in two neonates, a radiographically delineated enterolith in a child studied for an unrelated disorder, and a syndrome including pallor, fatigue, and anemia in four children aged 10 to 15 yr. Literature review uncovered 11 similar patients to 38 yr of age. Other symptoms in that group included intestinal obstruction and recurrent abdominal pain. At laparotomy all patients were found to have segmental saccular or tubular dilatation of the terminal ileum. The dilated segments varied in length from 8 to 25 cm. Meckel's diverticula were present in two patients. Segmental resection and anastomosis was performed in all patients. No lumenal stenosis was present in any specimen to account for the dilatation. Previous reports have referred to this abnormality as "giant Meckel's diverticulum" or "segmental ileal dilatation." Evaluation of these 18 patients suggests that this entity is an intrinsic abnormality of ileal development at the morphologically active site of juncture with the yolk stalk.

Idiopathic localized dilatation of the ileum in adults

The clinical and radiological features of idiopathic aneurysmal dilatation of the ileum in 3 adult patients are described. This uncommon lesion presents as an aperistaltic saccular segment in direct continuity with the normal ileal lumen. On barium examination of the small bowel, however, it may closely resemble and be mistaken for a Meckel's diverticulum. Previous reports about this entity manifesting in the pediatric age group are reviewed.

Segmental mega-ileum presenting as anaemia

Three cases are described of an unusual malformation of the ileum at the site of the vitelline duct, which presented with chronic anaemia. In each case localized mega-ileum was associated with a simple, non-specific ulcer leading to chronic blood loss. Two cases were at the site of and associated with a Meckel's diverticulum, while the third case was at the same level and associated with a vascular abnormality probably of vitelline artery origin. Ths syndrome of adult segmental ileal dilatation associated with non-specific ulcer and chronic anaemia does not appear to have been described previously.

Segmental dilatation of the ileum

Three new cases of congenital segmental dilatation of the ileum are presented and added to 12 cases of segmental dilatation found in the literature. The aspect of the condition which is of particular interest is the presence in 3 of the dilated segments of heteroplastic foregut derivatives of unusual varieties. The etiology of the condition is discussed; it does not appear to be a single distinct pathological entity.

Some unusual developmental heterotopias

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