J.Jpn. Surg. Soc.. 60(12): 1962-1978, 1960

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AN EVALUATION OF ILEOCECAL RESECTION FOR CHRONIC CONSTIPATION WITH REGARD TO HISTOPATHOLOGICAL STUDY ON RESECTED SPECIMENS

Ileocecal resection was performed for seventy-five cases complaining chronic constipation with ileocecal disorders such as pain, distention, unpleasant feeling and with abnormal x-ray findings such as adhesion, distention, ptosis, relaxation etc. in the ileocecal region with stasis of barium in it. From a comparative study of the histopathological, roentgenological, operative findings and the follow-up results, the following results were obtained :
1) Degenerative changes such as vacuole degeneration, atrophy and fibrization with variety in degree and extent were observed in the proper muscular layer of the bowel in all resected specimens. On the contrary, no histopathological findings were found in the control thirty specimens which got by autopsy except only two. So that it was thought that the lesion in the proper muscular layer of the resected specimens was correlated with chronic constipation.
2) It is difficult to consider that the histopathological changes will be secondary to the existing constipation, judging from the duration of constipation and the habitual use of laxatives or enemas.
3) In the cases in which adhesion was observed in the ileocecal region at the time of operation, the extention of histopathological changes over the cecocolic sphincter were frequently found, and the relaxation or the dilatation extending to the ascending colon and the hepatic flexure were often noticed roentgenologically. Resection including over half of the ascending colon for those cases brought a better results than those in which only ileocecal resection were performed.
4) Marked histopathological changes were often found in the cecum in cases with mobile cecum. Satisfactory results were obtained by ileocecal resection in those cases and also even in cases with movable ptotic ascending colon and hepatic flexure.
5) It does not seem that the manifestation of clinical symptoms in mobile cecum will be ascribed to the abnormal mobility and that idea of surgical treatment for it should be a morphological restoration.
(Author's abstract)

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