Acquired aganglionosis: A rare occurrence following pull-through procedures for Hirschsprung's disease

Karen W. West, Jay L. Grosfeld, Frederick Rescorla, Dennis W. Vane

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Hirschsprung's disease (HD) is a neurogenic form of intestinal obstruction characterized by a congenital absence of ganglion cells in the submucosal and myenteric plexuses. Acquired aganglionosis (AAG) is a rare condition that may occur following various pull-through procedures for HD. This report describes five boys with acquired aganglionosis. In all cases, the presence of normal ganglion cells was confirmed on review of biopsies of the pull-through segments at the initial operation. The original pull-through procedure included Soave (2), Duhamel (2), and Swenson (1) operations. Three procedures were initially performed at other institutions. Recurrent symptoms including abdominal distention, obstipation, enterocolitis, and failure to thrive developed 7, 11, 12, 18, and 30 months postoperatively (mean, 15.6 months). The diagnosis of AAG was delayed 1.5 to 9 years after the onset of recurrent symptoms. Full column barium enema studies revealed a transition zone or narrow area in the rectosigmoid or descending colon in four children. Repeat full thickness rectal biopsies at 3.0 cm above the anal verge in the pull-through segment confirmed the absence of ganglion cells in each case. Two children (post Swenson and Duhamel) were successfully revised with a Swenson procedure. Two additional children (post Soave and Duhamel) were successfully treated with extended posterior anomyomectomy procedures. The remaining boy now has a preliminary colostomy and is awaiting a second procedure. Vascular compromise of the distal bowel segment at the time of the initial pull-through procedure may contribute to the selective loss of ganglion cells postoperatively as neural tissues are most sensitive to hypoxia. This rare finding must be considered when recurrent obstructive symptoms develop following corrective surgery for HD and mechanical causes have been excluded.

Original languageEnglish
Pages (from-to)104-109
Number of pages6
JournalJournal of Pediatric Surgery
Volume25
Issue number1
DOIs
StatePublished - 1990
Externally publishedYes

Fingerprint

Hirschsprung Disease
Ganglia
Submucous Plexus
Descending Colon
Enterocolitis
Biopsy
Myenteric Plexus
Failure to Thrive
Colostomy
Intestinal Obstruction
Blood Vessels

Keywords

  • acquired aganglionosis
  • Hirschsprung's Disease
  • secondary aganglionosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Acquired aganglionosis : A rare occurrence following pull-through procedures for Hirschsprung's disease. / West, Karen W.; Grosfeld, Jay L.; Rescorla, Frederick; Vane, Dennis W.

In: Journal of Pediatric Surgery, Vol. 25, No. 1, 1990, p. 104-109.

Research output: Contribution to journalArticle

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abstract = "Hirschsprung's disease (HD) is a neurogenic form of intestinal obstruction characterized by a congenital absence of ganglion cells in the submucosal and myenteric plexuses. Acquired aganglionosis (AAG) is a rare condition that may occur following various pull-through procedures for HD. This report describes five boys with acquired aganglionosis. In all cases, the presence of normal ganglion cells was confirmed on review of biopsies of the pull-through segments at the initial operation. The original pull-through procedure included Soave (2), Duhamel (2), and Swenson (1) operations. Three procedures were initially performed at other institutions. Recurrent symptoms including abdominal distention, obstipation, enterocolitis, and failure to thrive developed 7, 11, 12, 18, and 30 months postoperatively (mean, 15.6 months). The diagnosis of AAG was delayed 1.5 to 9 years after the onset of recurrent symptoms. Full column barium enema studies revealed a transition zone or narrow area in the rectosigmoid or descending colon in four children. Repeat full thickness rectal biopsies at 3.0 cm above the anal verge in the pull-through segment confirmed the absence of ganglion cells in each case. Two children (post Swenson and Duhamel) were successfully revised with a Swenson procedure. Two additional children (post Soave and Duhamel) were successfully treated with extended posterior anomyomectomy procedures. The remaining boy now has a preliminary colostomy and is awaiting a second procedure. Vascular compromise of the distal bowel segment at the time of the initial pull-through procedure may contribute to the selective loss of ganglion cells postoperatively as neural tissues are most sensitive to hypoxia. This rare finding must be considered when recurrent obstructive symptoms develop following corrective surgery for HD and mechanical causes have been excluded.",
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