新生児小腸閉鎖症における腸管ペースメーカー細胞の臨床的研究

Small bowel atresia is a leading cause of neonatal intestinal obstruction and is frequently associated with postoperative gastrointestinal dysmotility. While factors like enteric nervous system alterations have been studied, the role of interstitial cells of Cajal (ICCs), the gut's pacemaker cells, remains under-investigated.

This study aimed to assess the density and distribution of ICCs in the atretic, proximal, and distal bowel segments in neonates with small bowel atresia and correlate their presence with postoperative outcomes.

A prospective study was conducted over two years at Institute of Child Health Niloufer Hospital, Hyderabad, including 44 neonates diagnosed with various types of small bowel atresia. Resected bowel segments were analyzed histologically and immunohistochemically using anti-CD117 (c-Kit) antibodies to identify ICCs. Clinical parameters such as age, type and location of atresia, postoperative bowel function, and survival were documented and statistically correlated with ICC distribution.

Among the 44 neonates (52.27% female), jejunal and ileal atresias were most common. The majority presented within the first five days of life. CD117 staining revealed sparse or absent ICCs in the atretic and proximal segments in neonates with delayed bowel function and poorer outcomes. In contrast, higher ICC expression was significantly associated with earlier stool passage and improved survival (p < 0.05).

A reduction in ICCs is a notable pathological feature of small bowel atresia. Their density in resected bowel segments significantly influences postoperative bowel motility and survival. ICC density assessment may serve as a prognostic indicator and guide surgical planning in affected neonates.