Surgical treatment of chagasic megacolon with Duhamel-Habr-Gama technique modulated by frozen-section examination.
BACKGROUND
Migration from Latin American countries has increased the number of cases of chagasic megacolon in Western countries. Megacolon is a late complication of Chagas disease, resulting from irreversible destruction of the intramural intestinal nervous system with extensive loss of neurons, ganglionitis, and myositis at the sites of the myenteric and submucosal plexuses. Several surgical procedures involving partial or total resection of the dilated colon have been proposed for treating chagasic megacolon, but intra-operative evaluation of neuronal degeneration in the residual colon has not been commonly done.


METHODS
Case report and literature review.


METHODS
We describe a case of chagasic megacolon treated successfully with a modified Habr-Gama technique, with the intra-operative examination of frozen sections of the residual segments of the colon for the presence of neurons.


CONCLUSIONS
The recurrence of constipation after surgical treatment can result from the progression of chagasic neuronal degeneration in the preserved colon, and may be preventable by intra-operative evaluation of whether signs of neuronal degeneration or inflammation are absent in the anastomosed colonic tract.
1 Digestive Surgery Unit, University of Florence , Florence, Italy .
Carmela
C
Di Martino
Gabriella
G
Nesi
Francesco
F
Tonelli
D014355:Chagas Disease / Q000150:complications*; D003106:Colon / Q000473:pathology*; D004733:Enema; D005260:Female; D005629:Frozen Sections; D006651:Histocytochemistry; D006801:Humans; D008531:Megacolon / Q000473:pathology* / Q000601:surgery*; D008853:Microscopy; D008875:Middle Aged; D010340:Pathology, Surgical / Q000379:methods*; D011860:Radiography, Abdominal; D013514:Surgical Procedures, Operative / Q000379:methods*