We subscribe to the HONcode principles of the Health On the Net Foundation
The preparation and microscopic investigation of biopsy specimens from the bowel for the diagnosis of chronic intestinal pseudo-obstruction is time consuming. There are several factors that explain this:
First, the neural system of the gut consists of well defined "knot-like" groups of neurons called ganglia and long, thin cytoplasma projections of the neurons called axons, which form nerve fibres. The usually 4 µm-thick histological sections contain only a part of each ganglion and in one section, which usually is 8-10 mm in length, there are normally no more than 20 ganglions, Hence, the number of neurons within one section is limited and quite low.
Secondly, not every single nerve cell is damaged by the pathologic process but either there is a mixtue of normal and injured cells or the abnormal cells are grouped in small patches or a single ganglion. This is valid for both neurons and smooth muscle cells.
Thirdly, conventional light microscopy on haematoxylin and eosin-stained sections is not sufficient for investigating changes in the enteric nervous system or the muscle layers. Special stains, immunohistochemistry, microscopic morphometry, and electron microscopy are usually needed in order to comfirm or refute the presence of visceral neuropathy or myopathy.
Fourthly, every morphological or architectural unit of the intestinal wall from the epithelial layer of the mucosa to the peritoneal mesothelium must be scrutinized under the microscope in order to make a diagnosis.
Sponsored by Socialstyrelsen (The National Board of Health and Welfare) and Karolinska Institutet. Copyright © 1997-2003 Greger Lindberg, MD.
All Rights Reserved.
@ki.se