[Histochemical diagnosis of Hirschsprung's disease and 2 point rectal mucosal biopsies for selection of surgical treatment].

In order to establish the diagnostic criteria of Hirschsprung's disease by Ach. E. staining of rectal mucosal biopsy, we analysed the specimen obtained from 110 infants with abdominal distension and constipation. We found the pattern of nerve fiber proliferation was not uniform even in patients with Hirschsprung's disease. The pattern was classified into 4 types. I. total layer type (Typical type), II. lamina propria mucosal type, III. lamina submucosal type, and IV. lamina propria mucosal and lamina submucosal type. In case of types II, III, IV which do not show a typical finding, detection of Meissner's ganglion cells is the most important factor for the diagnosis of Hirschsprung's disease. Since we confirmed that the Meissner's ganglion cells were always present at the level of just above to the dentate line of the rectum in the specimen of normal controls, we concluded that 5mm oral to the dentate line was the most appropriate position of the rectal mucosal biopsy for the diagnosis of Hirschsprung's disease including patients with ultrashort segment aganglionosis. Two points rectal mucosal biopsies, namely, the biopsies from the site of 5mm and 5 cm oral to the dentate line, was useful for selection of surgical treatment in patients with short segment aganglionosis.