Proximal Segment Histology of Resected Bowel in Hirschsprung's Disease Predicts Postoperative Bowel Function*

Abstract

The authors present an overview of 101 patients operated for Hirschsprung's disease by Rehbein procedure. Special attention is directed to the histomorphological findings in the proximal segment of the resected bowel specimens. A strong link was confirmed between these specific features and postoperative bowel function. A histologically regular proximal bowel segment generally predicted good postoperative bowel function with a constipation rate of 10.5%. In patients with intestinal neuronal dysplasia (IND) of the proximal segment the overall clinical result remained unchanged, although the constipation rate rose to 17.8%. Postoperative bowel function was seriously affected in cases characterized by proximal segment hypoganglionosis with a constipation rate of 23.1% and an additional 7.7% with encopresis. Finally, the distinct group of children with aganglionosis of the proximal segment followed a complicated postoperative course with secondary bowel resections and recurrent episodes of enterocolitis. In addition, the authors state their general observation that histological findings become less important whenever a more extensive resection than left hemicolectomy is required. Discussing the results, guidelines are given to further patient treatment once the particular proximal segment histology is diagnosed.

Intestinal Neuronal Dysplasia Type B: One Giant Ganglion is Not Good Enough

“…In severely constipated children, a temporary colostomy may be necessary. In patients with IND B in the context of Hirschsprung disease, 7.3% showed postoperative constipation [15,19] and needed a re-enterostomy or reresection. Rarely, in children over 4 years of age, a partial colectomy is unavoidable [29,36].…”

“…Some series yielded no differences [52]. In others, persistent obstructive symptoms seem to be more prevalent in patients with coexistent IND B [15,49]. For example, postoperative constipation was observed in 17.8% of patients with combined Hirschsprung disease and IND B, in comparison with 10.5% of Hirschsprung disease patients with no histopathology at their proximal resection margin [15].…”

“…Other investigators have used different criteria, including definitions of giant submucosal ganglia that range from .6 to .10 nerve cells per ganglion ( Table 2). Very few studies indicate the percentage of giant ganglion cells that are needed for the diagnosis, and many published reports fail to clearly state the specific criteria used to diagnose IND B [7,[15][16][17][18][19][20][21][22].…”

Calretinin, β‐Tubulin Immunohistochemistry, and Submucosal Nerve Trunks Morphology in Hirschsprung Disease

“…Numerous mutations discovered in HD-related genes (7,8), together with several proteins, whose expression was found to be altered in aganglionic bowel, do not actually add relevant help in the diagnostic, therapeutic, and prognostic pathway of this malformation. The persistence of aganglionosis or transition zone features (hypertrophic or hyperplasic nerves in presence of ganglion cells) has been demonstrated in patients with HD undergoing reoperation for intestinal obstructive signs and symptoms (11)(12)(13)(14). Standard histology plays an important role also in establishing the length of aganglionic and transitional tract during surgery to guide the surgical resection margin.…”

Relationships between Myers-Briggs Type Indicator (MBTI) Psychological Type and Marital Satisfaction, Divorce Proneness, Positive Affect, and Conflict Regulation in Clinic Couples

“…179,180 However, this has not been always substantiated, and further studies are required for clarification. Current histologic techniques do not allow us to detect any special abnormalities.…”