Primary myenteric plexus alterations as a cause of megacolon in Von Recklinghausen's disease.

This is a case report of a megacolon in a 26 years old male patient having typical von Recklinghausen's disease. Exploratory laparotomy shows no neurofibroma on digestive tract. Myenteric plexus study of colic resection specimen following B. Smith technique reveals marked alterations. These alterations are both quantitative (hyperhypoganglionosis) and qualitative (ganglion cells are irregular in shape and size, dendritic processes are hypertrophic, irregular; schwannosis; no inflammatory infiltration). The patient suffers no more transit disorders after adequate resection of this megacolon.

[Traumatic intestinal infarction (author's transl)]. / L'infarctus intestinal traumatique.

A study of 25 cases of traumatic intestinal infarction, often old cases, did not show any characteristic clinical picture or course but showed the following points: --abdominal contusion, even mild, may induce intestinal infarction, without any other intra- or retroperitoneal lesion. The frequency of infarction is low, but the notion of trauma is often neglected; --the ileum and ascending colon are most commonly involved, and infarction usually follows a thrombosis of the mesenteric veins. When there is an arterial infarction, this is usually due to mobilisation of an atheromatous plaque; --the clinical course usually includes an interval between the trauma and the infarction, due to a prodromic phase corresponding to the constitution then the extension of the thrombosis. These characteristics suggest a relationship between infarction and venous infarction in general, especially postoperative infarction, where there is local trauma and slowing of the circulation and hypercoagulability and raised platelet count. The treatment is nevertheless the same, associating intestinal resection and exploration with endarterectomy of the vascular pedicles and prolonged postoperative anticoagulant treatment.