A novel segmental absence of intestinal musculature with small intestinal stenosis: a case report

Colostomy fistula caused by segmental absence of intestinal musculature: a case report

BACKGROUND

Segmental Absence of Intestinal Musculature (SAIM) is a rare condition associated with intestinal obstruction and perforation. Colostomy fistula as a presentation of SAIM and their association with anastomotic failure have not been previously reported. This case report aimed to raise awareness of this unique manifestation and its potential implications.

CASE PRESENTATION

A 58-year-old male with a history of type 2 diabetes, hypertension, and lumbar hernia presented with diarrhea. Lower gastrointestinal endoscopy revealed a tumor in the rectum, for which he was diagnosed with a well-differentiated adenocarcinoma. The patient underwent a laparoscopic Hartmann operation. After the operation, an entero-entero-fistula was identified at the sigmoid colostomy site. Subsequently, laparoscopic reconstruction of the colostomy was performed, and the patient had a favorable postoperative course without complications. Histopathological examination confirmed the localized absence of the muscularis propria in the resected colon, with fibrosis and nearby ganglion cells.

CONCLUSIONS

This case highlights the rarity of a colostomy fistula as a manifestation of SAIM and emphasizes the need to consider SAIM in the differential diagnosis for such cases. The presence of SAIM-affected lesions poses a risk of anastomotic failure, underscoring the importance of assessing the risk of complications during future surgeries. Surgeons should be aware of the etiology and potential implications of SAIM to ensure appropriate management and minimize postoperative morbidity. Further studies are warranted to explore the underlying mechanisms and optimize surgical strategies for patients with SAIM and its associated complications. Increased awareness among clinicians is crucial for timely diagnoses and tailored interventions to improve patient outcomes.

Segmental absence of intestinal musculature in newborn: Case report

INTRODUCTION AND IMPORTANCE

Segmental absence of the muscularis propria intestinalis (SAIM) is a rare pathology characterized by a partial or complete absence of the intestinal musculature. Diagnosis requires histological confirmation, and treatment includes urgent laparotomy, resection of affected areas, and end-to-end anastomosis or creation of stomas. The work has been reported in line with the SCARE guideline criteria.

CASE REPORT

We present the case of a 31-week preterm newborn with prenatal diagnosis of polyhydramnios and non-immune fetal ascites. Radiological tests confirmed meconium peritonitis, and laparotomy was indicated. The patient had a torpid postoperative course requiring multiple surgeries due to intestinal occlusion and leakage of the anastomosis. Finally, he was discharged with good oral tolerance and bowel function. The anatomopathological examination reported the congenital absence of intestinal muscle with segmental and multifocal distribution.

CLINICAL DISCUSSION

Most neonatal cases share similar clinical features, and if SAIM is suspected during surgery, the suspicious areas should be resected to prevent future complications. The prognosis depends on the extent of the lesion, possibility of resecting affected segments, and concomitant pathologies.

CONCLUSION

In conclusion, this study aims to describe SAIM based on a clinical case and review of the literature. SAIM is a rare pathology that requires prompt diagnosis and treatment to prevent complications. Surgeons should consider resecting suspicious areas during surgery to prevent future complications.

Segmental Absence of Intestinal Musculature in a Child with Type IV Ehlers-Danlos Syndrome

Patients with vascular Ehlers–Danlos syndrome (vEDS) have a defect in the formation of type III collagen. This defect puts patients at risk of vascular rupture, uterine rupture, and bowel perforations. The segmental absence of intestinal musculature is a rare histopathologic finding, wherein there is a lack of a muscularis propria layer in the intestinal wall. Although typically documented in the literature in neonates or adults, it can be seen in children of other ages. This is a case report of a patient who exhibits both rare entities, which has not been described in the literature to date.