THE STRUCTURE OF THE TRANSITIONAL AND AGANGLIONIC ZONES OF AUERBACHS-PLEXUS IN PATIENTS WITH HIRSCHSPRUNGS-DISEASE - A COMPUTER-ASSISTED 3-DIMENSIONAL RECONSTRUCTION STUDY

Intestines resected from two patients with Hirschsprung's disease, bot h aged 6 months, were submitted to serial sectioning and three dimensi onal reconstruction to visualize the overall structure of Auerbach's p lexus and correlate its changes with functional abnormalities. Reconst ruction was made possible by using a graphics computer system. In norm al intestines taken from an autopsy case, both large and small, the pl exus was shown extending along the intermuscular septum as a regular n etwork. But in the large intestine, the density of the network was app arently higher and the individual bundles thicker than in the small in testine. This neural network was absent in the aganglionic zone in Hir schsprung's disease, as expected, where only hypertrophic extrinsic ne rves were running in the septum. The ''transitional zone'' of Hirschsp rung's disease was clearly definable as an area extending over a certa in length, where the network meshes grow more irregular and the bundle s taper more, toward the aganglionic zone. This finding was considered to be of profound significance in the design of a surgical strategy t o prevent postoperative bowel dysfunction. In determining the range of resection, one must consider not only the presence or absence of nerv e cells but also the grade of plexus hypoplasia. Copyright (C) 1996 by W.B. Saunders Company