Article

Immunohistochemical evaluations of ultrashort-segment Hirschsprung's disease

Surgical, Medical and Geriatric (GRECC) Services William S. Middleton Memorial Veterans Hospital Madison Wisconsin; Departments of Medicine and Surgery University of Wisconsin Madison Wisconsin; Division of Gastroenterology, Department of Medicine H6/516 Clinical Sciences Center 600 Highland Avenue 53792 Madison Wisconsin
Diseases of the Colon & Rectum (Impact Factor: 3.34). 06/1996; 39(7):817-822. DOI: 10.1007/BF02054450

ABSTRACT PURPOSE: Unlike classic Hirschsprung's disease, short-segment and ultrashort-segment varieties are usually found to be latent and milder. Ultrashort-segment Hirschsprung's disease may present as intractable chronic constipation in children over one year of age, adolescents, and adults. Anorectal myectomy has been shown in many instances to provide effective long-term treatment for certain patients with ultrashort-segment Hirschsprung's disease. Histologically, the affected segment in Hirschsprung's disease has been shown to have increased cholinergic nerves, lack of nitric oxide synthase-containing neuronal elements, and show moderate to severe loss of myenteric neurons. METHODS: Here, we report three cases that showed clinical and manometric evidence of ultrashort-segment Hirschsprung's disease. Two of the three patients responded well to myectomy. RESULTS: Detailed histologic and immunohistochemical evaluation of the internal anal sphincter and a comparison with three normal controls revealed absence of nitric oxide synthase-containing neurons in both cases that responded well to surgery and continued presence of these neurons in the patient who did not respond. A review of the current literature on various treatment modalities is included. CONCLUSIONS: Anorectal myectomy provides long-term relief of this chronic problem in a subgroup of patients with ultrashort-segment Hirschsprung's disease who lack nitrinergic neurons at the internal anal sphincter.

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