Restorative proctocolectomy with ileal reservoir: pathological and histochemical study of mucosal biopsy specimens.

Journal of Clinical Pathology - Tập 40 Số 6 - Trang 601-607 - 1987
Neil A. Shepherd1,2, J R Jass1,2, I Duval1,2, Robert L. Moskowitz1,2, R J Nicholls1,2, B C Morson1,2
1From the Departments of *Pathology, tSurgery, and the tImperial Cancer Research Fund Colorectal Cancer Unit, St Mark's Hospital, London, and the §Department ofHistopathology,
2St. Bartholomew’s Hospital, London

Tóm tắt

Mucosal biopsy specimens from the ileal reservoirs of 92 patients who had undergone restorative proctocolectomy (12 with familial adenomatous polyposis, 78 with ulcerative colitis, and two with functional bowel disease) were studied. Chronic inflammation was found in almost all, as was villous atrophy of varying severity. Other changes included pyloric metaplasia and mucosal prolapse. Acute inflammatory changes and ulceration were less common but, when present, corresponded to the clinical condition of "pouchitis". A grading system was devised to score acute and chronic inflammatory changes. There was a significant increase in acute inflammatory scores in ulcerative colitis compared with those in familial adenomatous polyposis, and pouchitis was present only in patients who had had ulcerative colitis; the morphological features of pouchitis are similar to those seen in the colorectal mucosa in ulcerative colitis. Histochemical studies of mucin in the reservoirs of mucosa showed that there may have been a change from small intestinal mucin to colonic mucin.

Từ khóa


Tài liệu tham khảo

l Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 1978;2:85-8.

Utsunomiya J, Iwama T, Imago M, etal. Total colectomy, mucosal proctectomy and ileoanal anastomosis. Dis Colon Rectum 1980;23:459-66.

Nicholls RJ, Pezim ME. Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: a comparison of three reservoir designs. Br J Surg 1985;72:470-4.

Moskowitz RL, Shepherd NA, Nicholls RJ. An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. International Journal of Colorectal Disease 1986;1: 167-74.

Spicer SS. The use of various cationic reagents in histochemical differentiation of mucopolysaccharides. Am J Clin Pathol 1961;5:393-407.

Madigan MR, Morson BC. Solitary ulcer of the rectum. Gut 1969;10:871-81.

Hulten L, Svaninger G. Facts about the Kock continent ileostomy. Dis Colon Rectum 1984;27:553-7.

Beart RW Jr, Fleming CR, Banks PM. Tubulovillous adenomas in a continent ileostomy after proctocolectomy for familial polyposis. Dig Dis Sci 1982;27:553-6.

Hamilton SR, Bussey HJR, Mendelsohn G, et al. Ileal adenomas after colectomy in nine patients with adenomatous polyposis coli/Gardner's syndrome. Gastroenterology 1979;77:1252-7.

Filipe Ml. Mucins in the human gastrointestinal tract: a review. Invest Cell Pathol 1979;2:195-216.

Jass JR, England J, Miller K. Value of mucin histochemistry in follow up surveillance of patients with long standing ulcerative colitis. J Clin Pathol 1986;39:393-8.

Dozois RR. Pathophysiology. Symposium; restorative proctocolectomy with ileal reservoir. International Journal of Colorectal Disease 1986;1: 14-5.

Moskowitz RL. Pathophysiology. Symposium; restorative proctocolectomy with ileal reservoir. International Journal of Colorectal Disease 1986;1:l16-7.

Nicholls RJ, Belliveau P, Neill M, Wilks M, Tabaqchali S. Restorative proctocolectomy with ileal reservoir: a pathophysiological assessment. Gut 1981;22:462-8.

Nasmyth DG, Godwin PGR, Dixon MF, Williams NS, Johnston D. The relationship between mucosal struciure and intestinal flora in ileal reservoirs. Br J Surg 1985;72:S 129.

Thông tin
Thông tin xuất bản

Journal of Clinical Pathology

Tập 40 Số 6

601-607

Thông tin tác giả