Institutional members access full text with Ovid®

Share this article on:

Significance of Abnormalities in Systems Proximal and Distal to the Obstructed Site of Duodenal Atresia

Alatas, Fatima S.; Masumoto, Kouji; Esumi, Genshiro; Nagata, Kouji; Taguchi, Tomoaki

Journal of Pediatric Gastroenterology & Nutrition: February 2012 - Volume 54 - Issue 2 - p 242–247
doi: 10.1097/MPG.0b013e31822d0d57
Original Articles: Gastroenterology

Background: Duodenal atresia (DA) is a well-known neonatal intestinal disease. Even after surgery, the proximal segment can continue to be severely dilated with hypoperistalsis, resulting in intestinal dysmotility problems in later life. No data have been published regarding the morphologic differences between the proximal and distal regions of obstructed sites of the intramural components in DA.

Methods: Operative duodenal samples (N = 12) from cases with DA (age 1–3 days) were used. Age-matched controls (N = 2) were used. All of the specimens were immunohistochemically stained with antibodies to S-100 protein, α-smooth muscle actin, and c-kit protein.

Results: At the proximal segments of the obstructed site in DA, the number of neuronal cells decreased in size and number. The circular musculature was moderately to severely hypertrophic. Unusual ectopic smooth muscle bundles were also identified. The innermost layer of the circular musculature was thinner. Interstitial cells of Cajal are decreased, even around the myenteric plexus. All of the staining in the distal segments in DA was similar to the control tissues.

Conclusions: Proximal and distal segments in DA differ in the neural cells, musculature, and distributions of the interstitial cells of Cajal. Based on the present study, these morphologic changes may contribute to the onset of postoperative duodenal dysmotility.

Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Address correspondence and reprint requests to Fatima S. Alatas, MD, Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan (e-mail: safira@pedsurg.med.kyushu-u.ac.jp).

Received 17 October, 2010

Accepted 9 July, 2011

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN