Guarino M P L, Carotti S, Cogliandro R, Stanghellini V, De Giorgio R, Barbara G, Alloni R, Altomare A, Tarquini E, Coppola R, Corinaldesi R, Cicala M
Digestive Disease Department, Campus Bio Medico University, Via Longoni 83, Rome, Italy.
Dig Liver Dis. 2008 Mar;40(3):225-9. doi: 10.1016/j.dld.2007.02.007. Epub 2007 Apr 11.
Chronic intestinal pseudo-obstruction represents a cause of persistent functional intestinal failure either "secondary" to specific conditions or "chronic intestinal idiopathic pseudo-obstruction" in origin. The diagnosis is mainly clinical, supported by radiological and/or endoscopic findings excluding any mechanical cause of intestinal obstruction. We reported a case of a 39-year-old woman with chronic intestinal idiopathic pseudo-obstruction, who underwent colectomy with ileorectal anastomosis; histological examination of the surgical specimen did not reveal myogenic or neurogenic defects or other pathological abnormalities indicative of an underlying neuromuscular impairment. Because of the apparent integrity of the gut neuromuscular layer, we tested whether a functional impairment affected colonic single smooth muscle cells. Muscle cells were isolated from the right colon and their contractile response to a receptor-dependent agonist evaluated in comparison to that obtained from controls. The cell contraction induced by acetylcholine in a dose response manner was markedly decreased in the patient affected by chronic intestinal idiopathic pseudo-obstruction compared with cells from controls (percentage of cell shortening with maximal dose of acetylcholine [10(-6)M]: 10.7+/-3% versus 34.2+/-4%, respectively). The present findings indicate a specific defect of colonic smooth muscle cells likely related to an ineffective response to acetylcholine.
慢性肠假性梗阻是导致持续性功能性肠衰竭的原因之一，其病因要么是继发于特定疾病，要么是原发性慢性特发性肠假性梗阻。诊断主要依靠临床症状，并结合影像学和/或内镜检查结果，以排除任何机械性肠梗阻的原因。我们报告了一例39岁患有慢性特发性肠假性梗阻的女性患者，她接受了结肠切除术并进行回肠直肠吻合术；手术标本的组织学检查未发现肌源性或神经源性缺陷，也未发现其他提示潜在神经肌肉损伤的病理异常。由于肠道神经肌肉层外观完整，我们测试了功能性损伤是否影响结肠单个平滑肌细胞。从右半结肠分离出肌肉细胞，并将其对受体依赖性激动剂的收缩反应与对照组进行比较评估。与对照组细胞相比，慢性特发性肠假性梗阻患者的细胞对乙酰胆碱以剂量反应方式诱导的收缩明显降低（最大剂量乙酰胆碱[10(-6)M]时细胞缩短百分比：分别为10.7±3%和34.2±4%）。目前的研究结果表明结肠平滑肌细胞存在特定缺陷，可能与对乙酰胆碱反应无效有关。
