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The first edition of the book on pathology of chronic constipation was drafted as an atlas folio. It enjoyed a brisk demand and sold out in the first year. This encouraged us to prepare the second edition 7 years later.

It has been demonstrated that enzyme histochemistry of native seromuscular intestinal biopsies allows the evaluation of nerve cell size and their dehydrogenase activity to recognize plexus immaturity in babies and inborn hypoplasia of the myenteric plexus in adults.

The acetylcholinesterase (AChE) activity of nerve fibers in circular and longitudinal muscles provides information about the motility performance of a particular intestinal part. This is important as it tells the surgeon whether an intestinal section is unable to transport its content properly, and it is a possible indication for resection in cases of negative findings. The nerve cell supply of the myenteric plexus and the parasympathetic tonus (AChE activity) of a proximal resection edge is a reliable source of information that the surgeon needs for a successful curative therapy.

Mucosa suction rectum biopsies offer a reliable diagnosis of an inborn aganglionosis (Hirschsprung’s disease) by the pathological increased AChE activity in parasympathetic nerves of mucosa and muscularis mucosae.

The use of native seromuscular intestinal biopsies, cut in a cryostat, avoids shrinking artefacts in circular muscles of the intestinal wall as is usually observed in formalin-fixed tissue. Shrinking artefacts of circular muscles prevents the pathologist from recognizing the extension of an atrophy or myopathy in circular muscles.

The heretofore neglected tendinous collagen net in the muscularis propria and plexus layer, which operates intestinal peristalsis, provides information about its stenotic effect if this structure is atrophied by inflammation or X-ray lesion. Crohn’s disease, diverticulitis, and ulcerative colitis destroy, via leukocytic collagenases, the tendinous net in muscularis propria and plexus layer, causing a stenotic symptomatology.

Architectural abnormalities of the muscularis propria as a doubling of the plexus layer explain focal stenotic symptoms. Smooth muscles myopathies are rare but serious reasons of an aperistaltic syndrome.

This book offers insights into many functional disturbances of intestinal motility, which are often not recognizable in formalin-fixed and standard HE-stained sections. It increases our diagnostic spectrum in chronic constipation. Histopathology of Chronic Constipation is an important reference book for pathologists in the diagnosis of chronic constipation; however, surgeons, gastroenterologists, and pediatricians will also find it important for understanding the reasons behind intestinal transport problems.

Acknowledgments

The authors are grateful to the staff of the Institute of Pathology of the University of Basel for their technical assistance.

Thanks go in particular to the technicians of the enzyme histochemical laboratory and the excellent work of Elisabeth Meier, Marlies Kasper, and Sabine Ipsen, all of whom made the book possible.

We sincerely thank Thomas Schürch of the photographic unit of the institute for the invaluable help in preparing and printing the illustrations.