Chronic intestinal pseudoobstruction ileus in a patient with rheumatoid arthritis: outcome of a stoma construction and its histopathological features.
We report the first case of a chronic intestinal pseudoobstruction (CIPO) in a patient with rheumatoid arthritis (RA) in whom a stoma was constructed at the sigmoid colon to decompress intracolonic pressure. The treatment improved quality of life in this patient, suggesting that surgical resection of the colon to decompress intracolonic pressure would be one of the options for the treatment of intractable CIPO. The resected specimen obtained from the sigmoid colon was found to be palisaded, with nuclei crowded in some areas of the inner circular muscle layer and thickened, with zonal or focal myxoid regions with interstitial fibrosis, composed of collagenous and elastic fibers, in the outer longitudinal muscle layer. Some of the smooth muscle cells in the outer longitudinal muscle layer showed mild degeneration with cytoplasmic vacuolar changes, but no inflammatory changes. However, further studies are required to determine whether these histopathological changes are unique to RA.
Department of Internal Medicine, Fukushima Red Cross Hospital, 11-31 Irie-cho, Fukushima 960-8530, Japan.
Masayuki
M
Miyata
Kazuo
K
Watanabe
Tomohiro
T
Suzuki
Naoto
N
Satoh
Tomomi
T
Sasajima
Go
G
Yamamoto
Kouta
K
Sugisaki
Yuta
Y
Takahashi
Yutaka
Y
Hoshino
Mitsukazu
M
Goto
Reiji
R
Kasukawa
Mitsuru
M
Saka
D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000473:pathology; D002908:Chronic Disease; D012809:Colon, Sigmoid / Q000473:pathology; D003125:Colostomy; D005260:Female; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D032389:Myocytes, Smooth Muscle / Q000473:pathology; D011859:Radiography