Introduction
Hirschsprung’s disease (HD) occurs in the newborn and childhood which
presents with signs of intestinal obstruction and constipation that
could have fatal complications if not diagnosed and treated on time (1).
The main underlying pathology of the disease is the migration deficiency
of neural crest cells during the development of the bowels in the fetal
period. Functional obstruction occurs due to the inability to a
relaxation of an aganglionic colon segment in the HH. Because of the
non-functional colon segment, dilatation in the proximal intestinal
segment occurs (2-5).
Hirschsprung’s disease occurs in approximately 1 in 5,000 live births,
and male to female ratio ranges from 3: 1 to 4: 1 (6-8). Most patients
are diagnosed during the newborn period. Patients are admitted to the
hospital with symptoms of distal intestinal obstruction such as bilious
vomiting, abdominal distention and inability to defecate in the first
24-48 hours of life (9). Sometimes, in infants with short seg
”ment HD, the disease may progress with mild symptoms, so that diagnosis
may delay until childhood period. Only up to 10% of patients are
diagnosed after the age of three (10, 11).
The diagnosis is made by demonstrating the complete absence of enteric
ganglion cells in the submucosal and myenteric plexuses of the distal
colon in pathology preparations. Rectal biopsy could be performed by two
methods: full-thickness rectal biopsy (FTRB) and suction rectal biopsy
(SRB) (12). Biopsies must be taken 2 cm above the dentate line to
prevent the mislead the diagnosis because below of dentate line is a
physiological aganglionic region (13).
Previous studies reported that anal dilatation, rectal irrigation and
barium enema used in the diagnosis and treatment of HD might contribute
to the insufficient biopsy taken due to the inflammation and oedema in
the anorectal mucosa, but these confining factors could not be excluded
due to the retrospective design of the studies (14).
The primary purpose of our study is to compare the effectiveness of SRB,
which is performed 48 hours after these procedures, with other studies.
The secondary purpose of this prospective study is to determine the
sufficiency rate of SRB samples for histopathological diagnosis and to
calculate the sensitivity and specificity of SRB after the
histopathological examination.