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Pathomorphologic study on ischemic lesions of the small and large intestine



Pathomorphologic study on ischemic lesions of the small and large intestine



Stomach & Intestine 28(9): 927-941



To evaluate ischemic lesions of the small and large intestine pathomorphologically, we examined 94 surgical and 2 autopsy specimens from 21 patients with superior mesenteric thrombosis or occlusion (SMA-EO), six patients with superior mesenteric venous thrombosis (SMVE), 20 patients with ischemic enteritis, 46 patients with ischemic colitis and three patients with phlebosclerosis. (1) The size of the lesions caused by SMA-EO was larger than that caused by SMV-E. In 20 acute lesions by SMA-EO, nine of them were anemic infarcts of the bowel macroscopically, and the others were a combination of anemic and hemorrhagic infarcts. Microscopic examination revealed that the lesions by SMV-E had more extensive hemorrhage, edema, and congestion than those by SMA-EO. (2) The stricture type of ischemic enteritis was macroscopically characterized by a tubular stenosis, and an annular and segmental ulcer. The microscopic features were summarized as follows: 1) Ul-II, III and IV ulcers, 2) open ulcers with vascular-rich granulation tissue in the center, 3) prominent fibromusculosis and fibrosis mainly located in the submucosa, 4) hemosiderin-laden macrophages scattered throughout the whole layers of the intestine, 5) organized thrombi in the blood vessels of the serosa (4 cases) and atheromatous emboli in the small arteries (one case). (3) The stricture type of ischemic colitis was macroscopically characterized by 2 or 3 longitudinal linear ulcers along the teniae coli, annular and segmental or serpiginous ulcers, and combined ulcers. The histological features of the ischemic colitis were almost the same as those of the ischemic enteritis. (4) All three lesions caused by phlebosclerosis were found in the right colon, especially in the cecum and ascending colon. The macroscopic characteristics of the lesions were a dark purple colored surface and marked thickening of the wall and disappearance of plicae semilunares coli. A healed Ul-III ulcer was found only in one patient. The microscopic characteristics were marked fibrous thickening of the venous wall with calcification, marked submucosal fibrosis, collagenous deposition around the blood vessels in the mucosa, foamy macrophages within the small vessel wall in the submucosa, but no thrombus in the vessels. We discuss the pathomorphologic characteristics, factors causing ischemic lesions and differences of the lesions caused by SMA-EO and SMV-E. Phlebosclerosis may be a new entity of ischemic colitis.

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