A correlative morphometric and clinical investigation of hypoganglionosis of the colon in children

Hypoganglionosis of the myenteric plexus of the colon is not clearly define d and seldom investigated. Colon segments from 15 children with an extended oligoneuronal hypoganglionosis up to the proximal resection end were morph ometrically studied and compared to normally innervated colon segments. The study was performed with resected specimens from 7 children with isolat ed hypoganglionoses, 8 children with a Hirschsprung-associated hypoganglion osis, and 12 colon segments with normal innervation. The resected colon specimens were caudo-cranial coiled. The native tissue w as frozen at - 80 degrees C on a cryostat carrier and cut at - 20 degrees C in 15 mu m-thick sections (equivalent to 4-5-mu m-thick paraffin sections) . The air-dried sections underwent an enzyme-histochemical procedure for an acetylcholinesterase reaction to stain the parasympathetically innervated myenteric plexus. For histological identification and morphometric measurem ents, ganglia and nerve cells were selectively stained using a lactic dehyd rogenase reaction. The morphometric measurements were performed with an optic-electronic image analysis system that determined ganglion size, ganglion distances, nerve c ell number per ganglion, and ganglion number per mm colon. The results showed that hypoganglionosis of the myenteric plexus is charact erised by a 42 % decrease in plexus area and a 55 % decrease of the nerve c ell number per mm length of colon. The number and area of myenteric ganglia showed a decrease of 59 % and a doubling of the ganglion distances. The histopathological diagnosis of a hypoganglionosis of the colon was not necessarily an indication of a chronic constipation, but rather an indicati on of a disposition for constipation. A chronic constipation is often cause d by a long hypoganglionic segment proximal to a resected short Hirschsprun g segment.