Histochemical staining of rectal suction biopsies as the first investigation in patients with chronic constipation

Abstract

Rectal suction biopsy (RSB) is the gold standard diagnostic procedure for disorders of bowel motility. This study describes our experience with RSB stained with histochemistry as the first diagnostic approach in a large series of patients presenting with chronic constipation. Between 1993 and 2005, 766 children underwent RSB for persistent chronic constipation. The specimens were snap frozen, sectioned and stained with conventional hematoxylin and eosin (H&E) and with nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) and acetylcholinesterase (AChE) histochemical stainings. Adequate amount of submucosa was present in 655 (85.5%) out of 766 cases and formed the basis of this study. RSB in 540 (82%) patients were reported as normal. Hirschsprung's disease was found in 47 (7.2%) patients with characteristic features of absence of ganglion cells, increased AChE activity in the lamina propria and muscularis mucosae, thick nerve fibers in the submucosa, and a lack of NADPH-d-positive fibers in muscularis mucosae. RSB in 59 (9%) patients presented features of intestinal neuronal dysplasia such as submucosal hyperganglionosis, giant ganglia, ectopic ganglia and increased AChE activity in lamina propria. Hypoganglionosis was suspected in nine (1.3%) children because of sparse or absent ganglion cells and low AChE and NAPDH-d activity in muscularis mucosae. Three patients (0.4%) developed bleeding following RSB, requiring diathermy of the bleeding point. Thus, we conclude that RSB is a simple and safe method when used as the first diagnostic approach in patients with chronic constipation. The combination of two histochemical stainings techniques provides a high level of accuracy in the diagnosis of intestinal dysganglionosis.

Rectal suction biopsy for the diagnosis of Hirschsprung’s disease: a systematic review of diagnostic accuracy and complications

“…Immediately after the procedure the patient may experience slight transient rectal bleeding, which usually settles spontaneously. Persistent rectal bleeding requiring blood transfusion occurred in approximately 0.5 % of all included RSBs [12,13,34,50,56,59,62,64]. Rectal perforation [12,13] and pelvic sepsis [12,13,36] have each been reported in less than 0.1 % of cases.…”

Hirschsprung's disease – Postsurgical intestinal dysmotility

“…The enterocolitis associated with HD is observed in 50% of cases, with a higher frequency at the first trimester and first year of life, may occur prior to or after surgery 7. The preoperative occurrence is more common when the diagnosis is made after the first month of life 7.…”

Massive bleeding after rectal suction biopsy: uncommon and unexpected delayed onset

“…[1][2][3] It represents a painless, safe, and effective technique that can be accomplished at the bed-space or in the outpatient setting without anesthesia or sedation. [4,5] Complications are rare and include specimen inadequacy, rectal perforation, and bleeding.…”

“…[5,6] The latter is experienced by less than 1% of patients undergoing RSBs and usually occurs immediately after the procedure. [2,4,[5][6][7][8] Rarely, bleeding persists and requires blood transfusion or some sort of intervention (diathermy or stitching of the bleeding wound). [2] We report a patient who experienced severe delayed rectal bleeding several days after a RSB.…”

“…[2,4,[5][6][7][8] Rarely, bleeding persists and requires blood transfusion or some sort of intervention (diathermy or stitching of the bleeding wound). [2] We report a patient who experienced severe delayed rectal bleeding several days after a RSB. To our knowledge, such a delayed bleeding onset has never been reported.…”