scholarly journals Ultrasonic diagnostics of Hirschsprung’s disease in adults

2013 ◽  
Vol 94 (5) ◽  
pp. 641-644
Author(s):  
A F Shakurov ◽  
O Yu Karpukhin ◽  
A F Yusupova ◽  
N Yu Savushkina
Keyword(s):  
Differential Diagnosis ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Rectal Wall ◽  
Rectal Mucosa ◽  
Correct Choice ◽  
Wall Thickening ◽  
Slow Transit Constipation ◽  
Muscular Layer ◽  
Inhibitory Reflex

Aim. To study the possibilities of hydrosonography for the differential diagnosis of Hirschsprung’s disease. Methods. The results of the examination of five patients with histologically confirmed diagnosis of Hirschsprung’s disease, 19 patients with slow transit constipation and 10 healthy volunteers are presented. Rectal ultrasonography was performed after retrograde colon filling with saline. Rectal lumen width, thickness and structure of the rectal mucosa and muscular layer were evaluated. The place of transition of rectal ampoule into the anal canal was thoroughly examined to determine rectal anal inhibitory reflex. Results. The following ultrasonic signs of Hirschsprung’s disease were identified: rectal wall thickening up to 6±0,7 mm due to muscular layer hypertrophy, hyperechoic mucosa, rectal lumen widening up to 60±5 mm. A high predictive value of ultrasonography for diagnosis of rectal anal inhibitory reflex absence in Hirschsprung’s disease (sensitivity 100%, specificity 96.7%, accuracy 97.1%). Advantages of the examination are obviousness and technical simplicity. With no introduction of a balloon, electrodes or ultrasonic detector into the rectal lumen, the results of examination can hardly be biased or miscomprehended. Conclusion. Hydrosonography might be used in diagnosis of Hirschsprung’s disease, this method facilitates the differential diagnosis of Hirschsprung’s disease and other forms of chronic constipation and contributes to the correct choice of treatment strategy.

Hirschsprung's Disease (Anganglionic megacolon)

PEDIATRICS ◽  
1959 ◽  
Vol 24 (1) ◽  
pp. 39-39
Keyword(s):  
Surgical Technique ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Ganglion Cells ◽  
Rectal Mucosa ◽  
Diagnostic Value ◽  
Radiologic Diagnosis ◽  
Comprehensive Review ◽  
Diagnosis And Management ◽  
Original Technique

This is a concise and comprehensive review of the essentials in the diagnosis and management of megacolon. The author pioneered in the development of a surgical technique for the treatment of megacolon. The experience with this technique has now become extensive and it has been remarkably successful. Comment on modifications of the original technique which have been proposed indicates that none of the modifications are superior and some are inferior. Particular attention is given to the diagnostic value of biopsy of the rectal mucosa and search for the characteristic abnormality, namely, failure of development of ganglion cells. Pitfalls in the radiologic diagnosis and pecularities of the disease in the newborn are discussed. This article contains many practical points regarding the diagnosis and management of megacolon.

Decreased TRK C may reflect developmental abnormalities in Hirschsprung's disease and idiopathic slow transit constipation

2001 ◽  
Vol 120 (5) ◽  
pp. A23
Author(s):  
Paul Facer ◽  
Charles H. Knowles ◽  
P.K. Thomas ◽  
Paul K.H. Tam ◽  
Norman S. Williams ◽  
...  
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Slow Transit Constipation ◽  
Developmental Abnormalities ◽  
Slow Transit ◽  
Transit Constipation

Calretinin versus Hematoxylin and Eosin Stain for Diagnosis of Hirschsprung’s Disease; Comparison in Ganglionic, Transitional, and Aganglionic Zones

2020 ◽  
Vol 103 (6) ◽  
pp. 559-565
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Ganglion Cells ◽  
Transitional Zone ◽  
Diagnostic Study ◽  
Double Blind ◽  
Muscular Layer ◽  
Rectal Suction Biopsy ◽  
Suction Biopsy ◽  
Hematoxylin And Eosin

Objective: To compare the results of calretinin stain with hematoxylin and eosin (H&E) stain for diagnosis of Hirschsprung’s disease. Materials and Methods: A prospective double-blind diagnostic study was done. Hirschsprung’s patients who underwent transanal endorectal pull through (TERPT) surgery between February 2015 and February 2017 were included. The pulled-through specimens were sampled at the ganglionic, transitional, and aganglionic zones. Each specimen was stained with calretinin and H&E. Agreement and kappa analysis were done. Results: Fifty-one Hirschsprung’s patients (153 specimens) were included for analysis. There were 37 males (72.5%) and 14 females (27.5%) with a median age at surgery of four months. Thirty-one specimens showed a negative stain for calretinin (aganglionic bowel) and 33 specimens showed no ganglion cells in the H&E stain. One hundred twenty-two specimens in calretinin stain were consistently positive with ganglionic bowel and 120 specimens in the H&E stain showed ganglion cells. Agreement and Cohen’s kappa coefficient were 97.4% and 0.921 (95% confidence interval 0.845 to 0.997), respectively. Disconcordance was found in four specimens. Three out of four were in the transitional zone. One was in the aganglionic zone, which has no muscular layer attached. (Thirty-six specimens had no muscular layer.) Conclusion: Calretinin stain was found to be comparable with the H&E stain and could be used for diagnosis of Hirschsprung’s disease. In rectal suction biopsy specimen in which the muscular layer was not included, both calretinin and H&E can be used. Keywords: Megacolon, Hematoxylin and eosin (H&E), Calretinin, Rectal suction biopsy (RSB), Full thickness biopsy

Rectal Biopsy as an Aid in the Diagnosis of Hirschsprung's Disease

PEDIATRICS ◽  
1956 ◽  
Vol 18 (2) ◽  
pp. 176-176
Keyword(s):  
Chronic Constipation ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Rectal Wall ◽  
Rectal Biopsy ◽  
Distal Segment ◽  
Large Bowel Obstruction ◽  
Atypical Symptoms ◽  
Typical History ◽  
History Of

The child with a typical history of chronic constipation, and with physical signs of a distended abdomen and an empty rectal ampulla, who is found to have a widely dilated colon with a narrow distal segment by the radiologist, presents no diagnostic problem. However, the diagnosis of Hirschsprung's disease may be very difficult to establish if part of the classical diagnostic criteria are absent or inconclusive. In such cases, the authors have found rectal biopsy to be a useful diagnostic procedure. They cite as indications for biopsy: (1) suspected Hirschsprung's disease in the newborn infant, because the colon does not become dilated and hypertrophied until the intestinal tract has been functioning for several months; (2) symptoms of upper large bowel obstruction developing soon after birth, because barium enema studies of infants whose entire colons are aganglionic reveal no obstruction of the lumen of the large intestine; (3) radiologic evidence of dilatation of the entire distal segment of the colon, because, in patients with a short aganglionic lesion, the obstruction may be so low that the radiologist is unable to demonstrate a narrow segment extending through the rectosigmoid, and (4) atypical symptoms of megacolon, including diarrhea, episodes of intestinal obstruction, or other symptoms of colonic dysfunction. This procedure has been performed by Swenson and his colleagues on 40 patients. Biopsy specimens obtained from 19 patients, subsequently proved to have Hirschsprung's disease by study of the resected rectum and sigmoid, contained no ganglionic cells. In the other 21 patients, biopsy was performed because Hirschsprung's disease was suspected. Ganglionic cells were present in all of these specimens, and the success of subsequent conservative management of these patients confirmed the diagnosis of chronic constipation. Control material was obtained from 10 cadavers with normal colons, and ganglionic cells were found in all of these specimens. The authors emphasize that this technique is only as good as the specimen obtained. An adequate biopsy of rectal wall must be removed. Multiple histologic sections must be carefully examined before the diagnosis of Hirschsprung's disease is confirmed.

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