Intestinal pseudoobstruction in a neonate caused by idiopathic muscular hypertrophy of the entire small intestine

Idiopathic muscular hypertrophy of the duodenum

There have not been any cases published of idiopathic muscular hypertrophy of the gastrointestinal tract in the past 20 years, mainly because it is a very rare condition of unknown aetiology. It is usually asymptomatic and presents mostly in the oesophagus of adult men.

Our case involves a 69 year old female that presented with a 6 week history of abdominal discomfort and weight loss. An upper endoscopy showed a blockage at the second portion of the duodenum and the upper gastrointestinal series demonstrated stenosis in the same location. An exploratory laparotomy discovered a mass involving 5 cm of the second portion of the duodenum with wall thickening measuring up to 1.3 cm in thickness. The histological report was muscular hypertrophy with mild eosinophils.

This is the first case reported with such a distinctive isolated involvement of the second part of the duodenum.

Supernumerary intestinal muscle coat in a patient with Hirschsprung disease/Mowat-Wilson syndrome

We present the 1st case report of an additional enteric smooth muscle layer in a patient with Mowat-Wilson syndrome and Hirschsprung disease. After resection of the aganglionic colon at the age of 5 months, our patient initially suffered from intermittent constipation, and subsequently by the age of 5 years, he developed ongoing diarrhea requiring medical treatment for more than a decade. Although the exact mechanism of abnormal gut motility in this case is unknown, we postulate that the supernumerary muscle and its associated neural plexus may be responsible for the patient's unusual late complication in treated Hirschsprung disease.

Architectural malformation of the muscularis propria as a cause for intestinal pseudo-obstruction: two cases and a review of the literature

Two patients are presented with intestinal pseudo-obstruction and malformations of their intestinal muscularis propria. Histopathological findings in each case indicate a distinct alteration of intestinal muscle architecture. The 1st patient, a teenager with lifelong constipation, had an additional circular muscle tunic in 2 dilated segments of his large intestine. The 2nd patient, an infant with multiple malformations, had diffuse abnormal layering of his small intestine. The rare reports of other individuals with similar pathological findings are discussed.

Neonatal-onset chronic intestinal pseudo-obstruction syndrome

Between January 1985 and January 1990, six cases of neonatal-onset chronic intestinal pseudo-obstruction syndrome (CIPS) were identified. Failure to gain weight in six cases, abdominal distention in five, and vomiting in five were the most common presenting symptoms. The contrast studies of the gastrointestinal tract demonstrated delayed transit time in 6/6, jejunal or ileal dilatation in 1/6, megaduodenum in 1/6, dilatation of the colon with barium retention in 4/6, and microcolon in 1/6. Urinary tract involvement was noted in three patients. Laparotomy, performed in three patients, revealed no mechanical obstruction. Except for hypoganglionosis in Patient 4, no recognizable neuropathy or myopathy was noted histopathologically. Four patients expired within 2 months after discharge. We conclude that CIPS with neonatal onset should be suspected when infants have urinary retention and abdominal distention or constipation beginning at birth or soon after. The prognosis of CIPS presenting in the newborn period appears worse than that presenting in childhood or adulthood.