Drexel University College of Medicine, Philadelphia, PA, USA.
Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Am Surg. 2023 Nov;89(11):5021-5023. doi: 10.1177/00031348231191198. Epub 2023 Jul 28.
Eosinophilic myenteric ganglionitis (EMG) is a rare pathologic finding within the Auerbach myenteric plexus characterized by eosinophilic infiltration on light microscopy. The plexus's ultimate obliteration results in chronic intestinal pseudo-obstruction (CIPO). EMG is almost exclusively seen in the pediatric population. The diagnosis of EMG is made through full-thickness rectal biopsy and EMG is not detectable through routine screening measures such as imaging or colonoscopy. The current treatment modality for this disorder is not standardized, and has often been treated with systemic steroids given its eosinophilic involvement. This case presents a 73-year-old male with chronic constipation presenting with new obstipation in the setting of recent orthopedic intervention requiring outpatient opioids. Admission radiographs were consistent with sigmoid volvulus. Following endoscopic detorsion, exploratory laparotomy revealed diffuse colonic dilation and distal ischemia requiring a Hartmann's procedure. Surgical pathology revealed EMG, increasing the complexity of subsequent surgical decision-making after his urgent operation.
嗜酸性性肌间神经节炎（EMG）是一种罕见的病理发现，其特征是在奥氏肌间神经丛中存在嗜酸性粒细胞浸润。该丛的最终闭塞导致慢性肠假性梗阻（CIPO）。EMG 几乎仅见于儿科人群。EMG 的诊断通过全层直肠活检进行，而通过常规筛查措施（如影像学或结肠镜检查）无法检测到 EMG。该疾病的当前治疗模式尚未标准化，由于其嗜酸性粒细胞参与，通常采用全身性类固醇治疗。本病例介绍了一名 73 岁男性，因慢性便秘就诊，近期接受骨科干预后需要门诊阿片类药物治疗，出现新的肠梗阻。入院放射照片与乙状结肠扭转一致。内镜松解后，剖腹探查显示弥漫性结肠扩张和远端缺血，需要进行 Hartmann 手术。外科病理显示 EMG，增加了他紧急手术后后续手术决策的复杂性。
