Abstract
Intestinal hypoganglionosis is a rare condition in adults. We report a case of intestinal hypoganglionosis in the mid-distal transverse colon to splenic flexure in a 65-year-old female patient presenting with altered bowel habit and abdominal distension, and reviewed the current literature on this topic. Our patient had a medical history of neurofibromatosis type 1. A preoperative computed tomography (CT) scan demonstrated a grossly dilated transverse colon without obstruction. A laparotomy for subtotal colectomy was performed, with histopathology demonstrating intestinal hypoganglionosis.
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References
Kapur RP. Intestinal motor disorders. In: Russo P, Ruchelli ED, Piccoli DA, editors. Pathology of pediatric gastrointestinal and liver disease. 2nd ed. Berlin : Springer; 2014. p. 270.
Dingemann J, Puri P. Isolated hypoganglionosis: systematic review of a rare intestinal innervation defect. Pediatr Surg Int. 2010;26:1111–5.
Taguchi T, Masumoto K, Ieiri S, et al. New classification of hypoganglionosis: congenital and acquired hypoganglionosis. J Pediatr Surg. 2006;41:2046–51.
Watanabe Y, Kanamori Y, Uchida K, et al. Isolated hypoganglionosis: results of a nationwide survey in Japan. Pediatr Surg Int. 2013;29:1127–30.
Yoshimaru K, Taguchi T, Obata S, et al. Immunostaining for Hu C/D and CD56 is useful for histopathological diagnosis of congenital and acquired isolated hypoganglionosis. Virchows Arch. 2017;470:679–85.
Puri P, Gosemann JH. Variants of Hirschsprung disease. Semin Pediatr Surg. 2012;21(4):310–8.
Best KE, Addor MC, Arriola L, et al. Hirschsprung’s disease prevalence in Europe: a register based study. Birth Defects Res A Clin Mol Teratol. 2014;100:695–702.
Suita S, Taguchi T, Ieiri S, et al. Hirschsprung’s disease in Japan: analysis of 3852 patients based on a nationwide survey in 30 years. J Pediatr Surg. 2005;40:197–201 (discussion -2).
Schäppi MG, Staiano A, Milla PJ, et al. A practical guide for the diagnosis of primary enteric nervous system disorders. JPGN. 2013;57:677–86.
Amiel J, Lyonnet S. Hirschsprung disease, associated syndromes, and genetics: a review. J Med Genet. 2001;38:729–39.
Knowles CH, De Giorgio R, Kapur RP, et al. Gastrointestinal neuromuscular pathology: guidelines for histological techniques and reporting on behalf of the Gastro 2009 International Working Group. Acta Neuropathol. 2009;118:271–301.
Antonucci A, Fronzoni L, Cogliandro L, et al. Chronic intestinal pseudo-obstruction. World J Gastroenterol. 2008;14:2953–61.
Muto M, Matsufuji H, Tomomasa T, et al. Pediatric chronic intestinal pseudo-obstruction is a rare, serious, and intractable disease: a report of a nationwide survey in Japan. J Pediatr Surg. 2014;49:1799–803.
Do MY, Myung SJ, Park HJ, et al. Novel classification and pathogenetic analysis of hypoganglionosis and adult-onset Hirschsprung’s disease. Dig Dis Sci. 2011;56:1818–27.
Swaminathan M, Kapur RP. Counting myenteric ganglion cells in histologic sections: an empiric approach. Hum Pathol. 2010;41:1097–108.
Jiang M, Li K, Li S, et al. Calretinin, S100 and protein gene product 9.5 immunostaining of rectal suction biopsies in the diagnosis of Hirschsprung’ disease. Am J Transl Res. 2016;8:3159–68.
Montedonico S, Caceres P, Munoz N, et al. Histochemical staining for intestinal dysganglionosis: over 30 years experience with more than 1,500 biopsies. Pediatr Surg Int. 2011;27:479–86.
Holland SK, Hessler RB, Reid-Nicholson MD, et al. Utilization of peripherin and S-100 immunohistochemistry in the diagnosis of Hirschsprung disease. Mod Pathol. 2010;23:1173–9.
Yoshimaru K, Taguchi T, Obata S, et al. Immunostaining for Hu C/D and CD56 is useful for a definitive histopathological diagnosis of congenital and acquired isolated hypoganglionosis. Virchows Arch. 2017;470:679–85.
Kim HJ, Kim AY, Lee CW, et al. Hirschsprung disease and hypoganglionosis in adults: radiologic findings and differentiation. Radiology. 2008;247:428–34.
Choi JS, Lim JS, Kim H, et al. Colonic pseudoobstruction: CT findings. AJR Am J Roentgenol. 2008;190:1521–6.
Kwok AMF, Still AB, Hart K. Acquired segmental colonic hypoganglionosis in an adult Caucasian male: a case report. World J Gastrointest Surg. 2019;11:101–11.
Schofield DE, Yunis EJ. Intestinal neuronal dysplasia. J Pediatr Gastroenterol Nutr. 1991;12:182–9.
Wu JF, Chen HL, Peng SS, et al. Neurofibromatosis type I and intestinal neuronal dysplasia type B in a child: report of one case. Acta Paediatr Taiwan. 2003;44:232–4.
Feinstat T, Tesluk H, Schuffler MD, et al. Megacolon and neurofibromatosis: a neuronal intestinal dysplasia. Case report and review of the literature. Gastroenterology. 1984;86:1573–9.
Bahuau M, Laurendeau I, Pelet A, et al. Tandem duplication within the neurofibromatosis type 1 gene (NF1) and reciprocal t(15;16)(q26.3;q12.1) translocation in familial association of NF1 with intestinal neuronal dysplasia type B (IND B). J Med Genet. 2000;37:146–50.
Kapur RP, Reyes-Mugica M. Intestinal neuronal dysplasia type B: an updated review of a problematic diagnosis. Arch Pathol Lab Med. 2019;143:235–43.
Kapur RP. Hirschsprung disease and other enteric dysganglionoses. Crit Rev Clin. 1999;36:225–73.
Shockett E, Telok HA. Aganglionic megacolon, pheochromocytoma, megalureter, and neurofibroma: co-occurrence of several neural abnormalities. Am J Dis Child. 1957;94:185–91.
Faussone-Pellegrini MS, Fociani P, Buffa R, et al. Loss of interstitial cells and a fibromuscular layer on the luminal side of the colonic circular muscle presenting as megacolon in an adult patient. Gut. 1999;45:775–9.
Holland-Cunz S, Goppl M, Rauch U, et al. Acquired intestinal aganglionosis after a lytic infection with varicella–zoster virus. J Pediatr Surg. 2006;41:e29-31.
Besnard M, Faure C, Fromont-Hankard G, et al. Intestinal pseudo-obstruction and acute pandysautonomia associated with Epstein–Barr virus infection. Am J Gastroenterol. 2000;95:280–4.
Matsui T, Iwashita A, Iida M, et al. Acquired pseudoobstruction of the colon due to segmental hypoganglionosis. Gastrointest Radiol. 1987;12:262–4.
Cho KM, Lim SU, Park SY. A case of colonic hypoganglionosis complicated with colonic ulcers. Soonshunhyang Med Sci. 2015;21:36–9.
Pescatori M, Mattana C, Castiglioni GC. Adult megacolon due to total hypoganglionosis. Br J Surg. 1986;73:765.
Wedel T, Roblick UJ, Ott V, et al. Enteric nerves and interstitial cells of Cajal are altered in patients with slow-transit constipation and megacolon. Gastroenterology. 2002;123:1459–67.
Munakata K, Fukuzawa M, Nemoto N. Histologic criteria for the diagnosis of allied diseases of Hirschsprung’s disease in adults. Eur J Pediatr Surg. 2002;12:186–91.
Ito T, Kimura T, Yagami T, et al. Megacolon in an adult case of hypoganglionosis, a pseudo-Hirschsprung’s disease: an autopsy study. Intern Med. 2008;47:421–5.
Qadir I, Salick MM, Barakzai A, et al. Isolated adult hypoganglionosis presenting as sigmoid volvulus: a case report. J Med Case Rep. 2011;5:445.
Figueiredo A, Martins I, Palma F, et al. Hypoganglionosis in pregnancy: a case report. J Med Case Rep. 2012;6:297.
Han EC, Oh HK, Ha HK, et al. Favorable surgical treatment outcomes for chronic constipation with features of colonic pseudo-obstruction. World J Gastrointest Surg. 2012;18:4441–6.
Gabbani T, Marsico M, Marocchi M, et al. Isolated hypoganglionosis in young man with autism. Dig Liver Dis. 2017;49:104.
Aldossary MY, Privitera A, Elzamzami O, et al. A rare case of adult-onset rectosigmoid hypoganglionosis. Am J Case Rep. 2018;19:557–61.
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Lee, A., Suhardja, T.S., Simpson, I. et al. Rare case of adult intestinal hypoganglionosis and review of the literature. Clin J Gastroenterol 14, 599–607 (2021). https://doi.org/10.1007/s12328-021-01342-5
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DOI: https://doi.org/10.1007/s12328-021-01342-5