Ganglion cell distribution in the normal rectum and anal canal A basis for the diagnosis of Hirschsprung's disease by anorectal biopsy

Current practice patterns of rectal suction biopsy in the diagnostic work-up of Hirschsprung’s disease: results from an international survey

“…The location of the most proximal biopsy site varied widely, ranging between 1 and 15 cm above the pectinate line and mostly from the proximal rectal wall. A number of previous studies have demonstrated that the distal 1-2 cm of rectum is normally hypoganglionic, and thus sampling from this area may lead to a false impression of aganglionosis [16,17]. Furthermore, there are significant differences regarding the number of specimens that are routinely taken, ranging from one to five samples per RSB.…”

Hirschsprung’s disease—A complicated therapeutic problem: Some thoughts and solutions based on data and personal experience over 56 years

“…This was fortunate because subsequent studies have documented that normally there is a band of aganglionic tissue adjacent to the sphincter. 38, 39 An important question to ask is what advantage to the patient is there in leaving part of the obstructive tissue in place. The mortality rate according to several reports is about the same or higher than in reports when the entire obstruction is removed.…”

A Practical Guide for the Diagnosis of Primary Enteric Nervous System Disorders

“…The reported mean neuronal densities, made both on transverse sections (TS) and longitudinal sections (LS) to avoid the above-mentioned bias, were for jejunum 3.6 to 3.7/mm for TS-LS, respectively; for ileum 4.3/mm (TS, LS); and for colon 7 to 7.7/mm (TS-LS) (46). The literature shows discrepancies in the mean number of ganglion cells per centimetre, ranging from 5 to 149 (46)(47)(48)(49)(50)(51)(52)(53). Because this variability exists in patients with normal innervation, it is clear that robust pathological abnormalities can be only determined once appropriated controls are established.…”