Ao Tadakazu, Shinto Eiji, Ide Asuma, Mori Shohei, Fujisawa Shigemoto, Nishikawa Makoto, Kurihara Ayumu, Takeo Hiroaki
Department of Surgery, Self-Defense Forces Central Hospital, Tokyo, Japan.
Department of Pathology, Self-Defense Forces Central Hospital, Tokyo, Japan.
J Anus Rectum Colon. 2025 Apr 25;9(2):270-275. doi: 10.23922/jarc.2024-091. eCollection 2025.
The etiology of eosinophilic myenteric ganglionitis (EMG) remains unclear. We present the case of a 62-year-old man who underwent right hemicolectomy with ileostomy and transverse colon mucous fistula due to ascending colon perforation. Pathological examination revealed severe eosinophilic infiltration in Auerbach's plexus and fibrosis extending from the external longitudinal muscle layer to the subserosal layer, suggesting that the perforation resulted from pseudo-obstruction and EMG-related increased intestinal pressure. Eosinophilic infiltration was observed not only near the perforation site but throughout the entire length of the resected intestine. Four months postoperatively, the patient underwent ileostomy closure, during which the ileal and colonic tracts left external to the wound were resected. Notably, no eosinophilic infiltration in Auerbach's plexus was found in the new specimen, unlike that in the previous surgical specimen, despite the patient receiving no postoperative medication. The patient has remained symptom-free for over 2 years. This is the first report to document histological time-course changes in eosinophil infiltration in Auerbach's plexus and demonstrate the efficacy of surgical treatment in a patient with EMG.
嗜酸性肌间神经节炎（EMG）的病因尚不清楚。我们报告一例62岁男性患者，因升结肠穿孔接受了右半结肠切除术并进行回肠造口术和横结肠黏液瘘手术。病理检查显示，奥尔巴赫神经丛有严重嗜酸性粒细胞浸润，纤维化从外纵肌层延伸至浆膜下层，提示穿孔是由假性肠梗阻和EMG相关的肠内压力升高所致。不仅在穿孔部位附近，而且在切除肠段的整个长度上均观察到嗜酸性粒细胞浸润。术后4个月，患者接受了回肠造口关闭术，术中切除了伤口外残留的回肠和结肠段。值得注意的是，尽管患者术后未接受药物治疗，但新标本中未发现奥尔巴赫神经丛有嗜酸性粒细胞浸润，与之前的手术标本不同。该患者已无症状超过2年。这是第一份记录奥尔巴赫神经丛嗜酸性粒细胞浸润组织学时间进程变化并证明手术治疗对EMG患者有效性的报告。
