Lymphogranuloma of the Colon

Abstract

THE voluminous literature recently accumulated on the subject of venereal lymphogranuloma contains no specific reference to involvement of the supra-anal portions of the colon by this condition. It is the purpose of this paper to describe three such cases complicating known rectal involvement: two in the transverse colon and one extensively in the descending and sigmoid. History.—Copeland, as early as 1811, suspected the venereal origin of stricture of the rectum. The condition was established as a definite pathological entity by the publication, in 1913, of a monograph by the Frenchmen, Nicolas, Durand, and Favre. It remained for Frei, in 1925, to introduce a diagnostic skin test based on a specific skin reaction which immediately placed the differential diagnosis on a sound basis. In 1930, the disease was transmitted to animals (monkeys) by intracerebral inoculations by the Swedish scientists, Hellerström and Wassen. Levaditi later substituted the mouse as a more suitable animal for experimentation. In 1932, Wolf, Sulzberger, and Wise introduced the cutaneous test in this country. Etiology.—The disease is due to an unknown filtrable virus and its frequency varies directly with the degreee of sex hygiene rather than racial susceptibility. Venereal lymphogranuloma is not related to granuloma inguinale, another venereal disease consisting of chronic, luxuriant ulcers produced by Donovan's bodies. The disease produces definite systemic reactions such as fever, headaches, secondary anemia, hyperglobulinemia, high sedimentation rate, and anti-complementary Wassermann reactions, in addition to the long described local acute and chronic tissue responses. Pathology.—Involvement of the colon grossly occurs by the formation of a granuloma and microscopically by the usual picture seen in a chronic non-specific granulomatous reaction, there being no pathognomonic pathological picture in this disease. Pathogenesis.—The anatomical basis for the sequelæ of venereal lymphogranuloma of the rectum is mostly stasis due to the occlusion of the lymphatics by destruction of the lymph glands, resulting in ulceration, elephantiasis, and fistulæ formation which is responsible for the spread to the buttocks and other extensions upward, such as parametritis and peritonitis. Roentgen Diagnosis.—The disease is manifested roentgenographically in the rectum by the demonstration of either extensive exudative inflammation, stricture, or fistulæ formation, depending on the stage of the disease. The changes higher in the colon are similar, and when found associated with known rectal involvement, must be considered as due to the same etiology. It is not the province of this paper to enumerate the clinical diagnostic criteria for the rectal diagnosis (history, controlled Frei tests, biopsy, etc.) but, whenever a case so labelled clinically shows an associated colon lesion and further shows reactions to the Frei therapeutic antigen, the etiology is self-evident.