Advances in our understanding of the pathology of chronic intestinal pseudo-obstruction

Abstract

Chronic intestinal pseudo-obstruction (CIP) represents a particularly difficult clinical challenge. It is a rare and highly morbid syndrome characterised by impaired gastrointestinal propulsion together with symptoms and signs of bowel obstruction in the absence of any lesions occluding the gut lumen. CIP can be classified as either "secondary" to a wide array of recognised pathological conditions or "idiopathic" (CIIP). This review will focus on CIIP, and specifically on the underlying pathological abnormalities. Combined clinical and histopathological studies are needed to highlight new perspectives in the understanding and management of chronic intestinal pseudo-obstruction.

Figure 1

Representative photomicrograph illustrating a case of idiopathic lymphocytic myenteric ganglionitis. The immune infiltrate is localised within the myenteric plexus of the small bowel of a patient with chronic intestinal idiopathic pseudo-obstruction. The positive immunolabelling (light red/pink colour) identifies CD8 T lymphocytes (A). The inset selected (B) is a higher magnification of (A) showing the close proximity between CD8 positive lymphocytes and myenteric neurones (arrows). Alkaline phosphatase antialkaline phosphatase immunohistochemical technique. Original magnifications: 80×, A; 160×, B.