Rectal mucosal biopsy compared with laparoscopic seromuscular biopsy in the diagnosis of intestinal neuronal dysplasia in children with slow-transit constipation

Background/Purpose: Intestinal neuronal dysplasia (IND) as a cause for seve re chronic constipation remains controversial. The aim of this study is to examine the correlation between a deficiency of substance P (SP) immunoreac tive nerve fibers in the colon and enzyme histochemistry of rectal biopsies in children with slow-transit constipation. Methods: Fifty children with intractable constipation have been assessed by rectal biopsies examined with histochemical staining for lactate dehydroge nase, and 32 children among those 50 have been studied by laparoscopic sero muscular biopsy of the colon labelled with antibodies to SP using immunoflu orescence methods. Results: Four children have evidence of IND. Fifteen children, including al l 4 IND cases, showed a deficiency of SP immunoreactivity. There is a signi ficant correlation between giant ganglia and SP deficiency (P < .01). Conclusion: This study is attempting to propose that a deficiency of SP imm unoreactivity in colonic circular muscle nerves may be used as a histologic marker for slow-transit constipation and that IND may be a small subset of patients with SP deficiency. J Pediatr Surg 35:1724-1727. Copyright (C) 20 00 by W.B. Saunders Company.