CC BY 4.0 · European J Pediatr Surg Rep 2019; 07(01): e55-e57
DOI: 10.1055/s-0039-1693494
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Pullthrough Operation for Hirschsprung's Disease: Importance of a Circumferential (Donut) Biopsy at the Level of the Anastomosis

Susan Jehangir
1  Department of Paediatric Surgery, Christian Medical College, Vellore, India
2  Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
,
Soundappan Venkatraman Sannappa Soundappan
2  Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
,
Micheal Krivanek
3  Department of Anatomical Pathology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
,
Susan Arbuckle
3  Department of Anatomical Pathology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
,
Nicole Graf
3  Department of Anatomical Pathology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
› Author Affiliations
Funding None.
Further Information

Publication History

20 January 2019

07 June 2019

Publication Date:
15 July 2019 (online)

  

Abstract

Hirschsprung's disease is characterized by the absence of ganglia in the distal colon, resulting in a functional obstruction. It is managed by excision of the aganglionic segment and anastomosis of the ganglionated bowel just above the dentate line. The level of aganglionosis is determined by performing multiple seromuscular biopsies and/or full thickness biopsy on the antimesenteric border of the bowel to determine the level of pullthrough. The transition zone is described as being irregular, and hence a doughnut biopsy is recommended so that the complete circumference can be assessed. Herein, we described a child in whom there was a selective absence of ganglion cells in 30% of the circumference of the bowel along the mesenteric border for most of the transverse colon. This case defies the known concept of neural migration in an intramural and transmesenteric fashion and emphasizes the importance of a doughnut biopsy of the pulled-down segment.