THE STRUCTURE OF THE TRANSITIONAL AND AGANGLIONIC ZONES OF AUERBACHS-PLEXUS IN PATIENTS WITH HIRSCHSPRUNGS-DISEASE - A COMPUTER-ASSISTED 3-DIMENSIONAL RECONSTRUCTION STUDY
H. Miura et al., THE STRUCTURE OF THE TRANSITIONAL AND AGANGLIONIC ZONES OF AUERBACHS-PLEXUS IN PATIENTS WITH HIRSCHSPRUNGS-DISEASE - A COMPUTER-ASSISTED 3-DIMENSIONAL RECONSTRUCTION STUDY, Journal of pediatric surgery, 31(3), 1996, pp. 420-426
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