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Gupta M, Kumar A, Singla V, Aggarwal S, Das P. Subserosal Supernumerary Muscle Layer of the Intestine: A Peculiar Bowel. Cureus 2024; 16:e60096. [PMID: 38860074 PMCID: PMC11164246 DOI: 10.7759/cureus.60096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 06/12/2024] Open
Abstract
The presence of a supernumerary subserosal muscle layer of the bowel is an extremely unusual congenital development. The following is a report of diffuse involvement of the intestine with a supernumerary subserosal muscle coat. The current patient, a 29-year-old male, was evaluated in January 2022 for a long-standing history of subacute intestinal obstruction (SAIO). A preoperative CT scan of the abdomen and pelvis suggested mild dilatation and clumping of ileal loops in the right iliac fossa, with a subtle wall thickening of up to 5 mm. Intraoperatively, dense adhesions were noted between clumped bowel loops and the anterior abdominal wall. Following adhesiolysis, ileocecal resection with ileocolic anastomosis was done. The histopathological examination of the resected bowel segment showed irregular hypertrophy of circular and longitudinal muscle layers with the presence of an additional smooth muscle coat outer to the outer longitudinal layer that was seen in the ileum as well as the appendix. No evidence of vacuolar degeneration was noted, and ganglion cells were seen to be adequately present. The presence of additional smooth muscle bundles in the subserosa was confirmed with positive actin immunostaining. Additionally, CD117 staining was done that revealed a normal network of interstitial cells of Cajal. No evidence of active inflammation was noted in the resected bowel segment. Findings from the current case bring to light an extremely rare malformation of the muscularis propria of the intestine, namely a supernumerary subserosal muscle coat.
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Affiliation(s)
- Mehul Gupta
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Arun Kumar
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Vitish Singla
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Sandeep Aggarwal
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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Mahalik SK, Patra S, Tripathy BB, Pati AB, Mohanty MK, Samal SC. Segmental dilatation of ileum in a child with juvenile idiopathic arthritis, localized myopathy with focal stasis induced immunogenic injury as a possible etiology: a case report. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00099-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Segmental dilatation of the intestine (SDI) though uncommon is a well-known entity and more than 150 cases of SDI are reported in the literature. The presentation and association of SDI are well described; however, the association of SDI with juvenile idiopathic arthritis (JIA) has not been reported earlier. We described a case of SDI with JIA, who presented with malnutrition and chronic abdominal distension.
Case presentation
A 5-year-old female child was getting treated for JIA and referred to us for evaluation of chronic abdominal distension. On laparotomy, a huge SDI was found approximately 40 cm from the ileocecal junction and resection of the dilated part with approximately 2–3 cm of healthy ileum on each side and anastomosis was performed. The child recovered well and the features of arthritis also resolute 6 weeks later. From histologic analysis, we have suggested role of localized myopathy in development of segmental dilatation. We have further emphasized the link between the SDI with development of arthritis.
Conclusion
Etiology of SDI is multifactorial with architectural malformation of the smooth muscle due to localized myopathy is the key. Focal stasis in SDI affecting permeability and increased exposure to macromolecules, and antigens may give rise to immune-mediated arthritis. Surgical management can reduce and cure the symptoms of such patients.
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Anand S, Dhua AK, Sankar J, Das P, Goel P, Bajpai M, Sharma A. Segmental Ileal Dilatation Presenting with Neonatal Intestinal Obstruction. J Indian Assoc Pediatr Surg 2020; 25:306-309. [PMID: 33343112 PMCID: PMC7731999 DOI: 10.4103/jiaps.jiaps_135_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/12/2019] [Accepted: 01/04/2020] [Indexed: 11/08/2022] Open
Abstract
Segmental ileal dilatation is an uncommon cause of neonatal intestinal obstruction. This report highlights a rare combination of abnormal distribution of muscles in the muscularis propria and partial loss of interstitial cells of Cajal as causative factors for segmental intestinal dilatation.
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Affiliation(s)
- Sachit Anand
- Department of Paediatric Surgery, All India Institute of Medical Sciences, Delhi, India
| | - Anjan Kumar Dhua
- Department of Paediatric Surgery, All India Institute of Medical Sciences, Delhi, India
| | - Jeeva Sankar
- Department of Paediatrics, All India Institute of Medical Sciences, Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, Delhi, India
| | - Prabudh Goel
- Department of Paediatric Surgery, All India Institute of Medical Sciences, Delhi, India
| | - Minu Bajpai
- Department of Paediatric Surgery, All India Institute of Medical Sciences, Delhi, India
| | - Akash Sharma
- Department of Paediatrics, All India Institute of Medical Sciences, Delhi, India
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Nakagawa Y, Harada T, Kaneoka Y. Congenital segmental dilatation of the intestine in extremely low birth weight infants. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Congenital segmental intestinal dilatation: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sergi C, Hager T, Hager J. Congenital Segmental Intestinal Dilatation: A 25-Year Review with Long-Term Follow-up at the Medical University of Innsbruck, Austria. AJP Rep 2019; 9:e218-e225. [PMID: 31304051 PMCID: PMC6624109 DOI: 10.1055/s-0039-1693164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/26/2019] [Indexed: 12/24/2022] Open
Abstract
Background and Aim Congenital segmental intestinal dilatation (CSID) is a neonatal condition with unclear etiology and pathogenesis. Typically, the newborn with CSID presents with a limited (circumscribed) bowel dilatation, an abrupt transition between normal and dilated segments, neither intrinsic nor extrinsic perilesional obstruction, and no aganglionosis or neuronal intestinal dysplasia. We aimed to review this disease and the long-term follow-up at the Children's Hospital of the Medical University of Innsbruck, Tyrol, Austria. Study Design Retrospective 25-year review of medical charts, electronic files, and histopathology of neonates with CSID. Results We identified four infants (three girls and one boy) with CSID. The affected areas included duodenum, ileum, ascending colon, and sigmoid colon. Noteworthy, all patients presented with a cardiovascular defect, of which two required multiple cardiac surgical interventions. Three out of the four patients recovered completely. To date, the three infants are alive. Conclusion This is the first report of patients with CSID and cardiovascular defects. The clinical and surgical intervention for CSID also requires a thorough cardiologic evaluation in these patients. CSID remains an enigmatic entity pointing to the need for joint forces in identifying common loci for genetic investigations.
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Affiliation(s)
- Consolato Sergi
- Department of Orthopedics, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, Hubei, P.R. China.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas Hager
- Institute of Pathology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,Institute of Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Josef Hager
- Department of Pediatric Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Johnson L, Simone K, Cullen J, Talley A, Cohen EB. Radiographic features of congenital segmental dilation of the intestine in a german shepherd dog. Vet Radiol Ultrasound 2017; 60:E62-E65. [PMID: 29205622 DOI: 10.1111/vru.12581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 11/28/2022] Open
Abstract
A 10-week-old spayed female German Shepherd Dog was presented for acute vomiting and diarrhea. There was no reported foreign body or toxin ingestion. Radiographs showed a severely (∼11 × 7 cm), focally distended right abdominal intestinal segment containing gas and soft tissue material. Other small intestinal segments were segmentally gas distended. Celiotomy identified a ∼9 cm focally dilated segment at the jejunoileal junction with no aborad luminal obstruction. Resection and anastomosis of the dilation was performed. Histopathology showed mild mucosal inflammation, but otherwise normal wall layering and autonomic ganglia. Radiographic and histopathologic findings were consistent with congenital segmental dilation of the intestine.
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Affiliation(s)
- Laura Johnson
- North Carolina State University College of Veterinary Medicine, Raleigh, NC, 27607
| | - Kristina Simone
- Molecular Biomedical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, 27606
| | - John Cullen
- Department of Population Health and Pathobiology, North Carolina State University College of Veterinary Medicine, Raleigh, NC, 27607
| | - Ashley Talley
- Molecular Biomedical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, 27606.,Department of Population Health and Pathobiology, North Carolina State University College of Veterinary Medicine, Raleigh, NC, 27607
| | - Eli B Cohen
- Molecular Biomedical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, 27606
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Absence of the interstitial cells of Cajal in a neonate with segmental dilatation of ileum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2015.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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