An inflammatory axonopathy of the myenteric plexus producing a rapidly progressive intestinal pseudoobstruction

Gastroenterology
S KrishnamurthyA I Schweid

Abstract

A previously well 39-yr-old man presented with a 4-wk history of abdominal pain, nausea, vomiting, and weight loss. An upper gastrointestinal examination showed retained food in the stomach and duodenal dilatation. A radioisotope meal showed little gastric emptying; esophageal manometry was normal. Because of persistent symptoms, a duodenojejunostomy was done. However, the patient remained symptomatic and after an episode of profuse vomiting, aspirated and died 10 wk after initial presentation. At autopsy, no tumor was found. Hematoxylin and eosin stains throughout the gastrointestinal tract showed many lymphocytes and plasma cells within the myenteric plexus. Silver stains showed the argyrophilic and argyrophobic neurons to be normal, but axons showed beading, fragmentation, and dropout in all areas. We therefore concluded the following: intestinal pseudoobstruction can be caused by an inflammatory neuropathy of the myenteric plexus, not associated with a distant carcinoma, and this process produced an axonopathy while sparing neuron bodies.

Citations

Jul 4, 1998·Parasite Immunology·B A Vallance, S M Collins
Jun 18, 1999·Journal of Clinical Gastroenterology·J E LosanoffE T Katrov
Mar 17, 2000·Scandinavian Journal of Gastroenterology·R De GiorgioC Sternini
Jun 16, 2001·American Journal of Physiology. Gastrointestinal and Liver Physiology·W I KhanS M Collins
Oct 27, 2004·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·R De Giorgio, M Camilleri
May 18, 1999·The American Journal of Surgical Pathology·S Schobinger-ClémentT Stallmach

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