International Journal of Colorectal Disease

, Volume 27, Issue 9, pp 1175–1180 | Cite as

A rapid lactate dehydrogenase histochemical method for the intraoperative assessment of Hirschsprung's disease

  • Ning Li
  • Lei Xiang
  • Xiaojuan Wu
  • Jixin Yang
  • Jia Wei
  • Jiexiong Feng
Original Article
First Online:
Accepted:

Abstract

Purpose

The aim was to assess the ability of a fast lactate dehydrogenase (LDH) staining technique to evaluate the boundary of the abnormal bowel segment in Hirschsprung's disease (HD) as a guide for surgical resection.

Methods

Seventy children diagnosed with HD were equally divided into two groups. For the study group, fast LDH staining was used to confirm the diagnosis and determine the boundary of abnormal bowel. Frozen H&E staining was applied to the control group. Postoperatively, bowel samples were examined by paraffin H&E staining to confirm the intraoperative diagnosis. Patients received a follow-up analysis, and bowel function was scored and compared between the two groups.

Results

In the study group, 19 children were diagnosed with isolated HD, and the remaining had HD in combination with HD-allied disorders (HAD). The diagnosis was identical to the post-operative H&E staining, and the ganglia cells at the proximal end of the resected bowel were normal. In the control group, 30 children were diagnosed with isolated HD. However, the paraffin H&E staining showed that only 16 cases had isolated HD, and the remaining had a combined diagnosis of HAD. Moreover, 12 of these allied disorders were found at the proximal end of the resected bowel. Patients received follow-up for 6–15 months. The bowel function score of the study group was significantly higher than the control group.

Conclusions

Fast LDH staining can clearly identify ganglion cells and rapidly diagnose HD and HAD intraoperatively. In addition, this method is helpful for improving patient prognosis.

Keywords

Hirschsprung's disease (HD) Hirschsprung's disease-allied disorders (HAD) Lactate dehydrogenase (LDH) Intraoperative diagnosis 
This is a preview of subscription content, log in to check access.

Notes

Source of funding

The Scientific Research Foundation for the Returned Overseas Chinese Scholars, State Education Ministry, no. 2008-890, provided funding for this study.

Disclosures

The authors report no relevant disclosures.

References

  1. 1.
    Meier-Ruge W (1992) Epidemiology of congenital innervation defects of the distal colon. Virchows Arch A Pathol Anat Histopathol 420(2):171–177PubMedCrossRefGoogle Scholar
  2. 2.
    Ure BM, Holschneider AM, Meier-Ruge W (1994) Neuronal intestinal malformations: a retro- and prospective study on 203 patients. Eur J Pediatr Surg 4(5):279–286. doi: 10.1055/s-2008-1066118 PubMedCrossRefGoogle Scholar
  3. 3.
    Ure BM, Holschneider AM, Schulten D, Meier-Ruge W (1997) Clinical impact of intestinal neuronal malformations: a prospective study in 141 patients. Pediatr Surg Int 12(5–6):377–382PubMedCrossRefGoogle Scholar
  4. 4.
    Meier-Ruge WA, Brunner LA (2001) Morphometric assessment of Hirschsprung's disease: associated hypoganglionosis of the colonic myenteric plexus. Pediatr Dev Pathol 4(1):53–61PubMedCrossRefGoogle Scholar
  5. 5.
    Wu X, Feng J, Wei M, Guo X, Li R, Xuan X, Yang J (2009) Patterns of postoperative enterocolitis in children with Hirschsprung's disease combined with hypoganglionosis. J Pediatr Surg 44(7):1401–1404. doi: 10.1016/j.jpedsurg.2008.11.004 PubMedCrossRefGoogle Scholar
  6. 6.
    Kobayashi H, Hirakawa H, Surana R, O'Briain DS, Puri P (1995) Intestinal neuronal dysplasia is a possible cause of persistent bowel symptoms after pull-through operation for Hirschsprung's disease. J Pediatr Surg 30(2):253–257. doi: 0022-3468(95)90570-7 [pii], Discussion 257–259PubMedCrossRefGoogle Scholar
  7. 7.
    Schulten D, Holschneider AM, Meier-Ruge W (2000) Proximal segment histology of resected bowel in Hirschsprung's disease predicts postoperative bowel function. Eur J Pediatr Surg 10(6):378–381. doi: 10.1055/s-2008-1072395 PubMedGoogle Scholar
  8. 8.
    Beschorner R, Mittelbronn M, Bekure K, Meyermann R (2004) Problems in fast intraoperative diagnosis in Hirschsprung's disease. Folia Neuropathol 42(4):191–195PubMedGoogle Scholar
  9. 9.
    Meier-Ruge WA, Ammann K, Bruder E, Holschneider AM, Scharli AF, Schmittenbecher PP, Stoss F (2004) Updated results on intestinal neuronal dysplasia (IND B). Eur J Pediatr Surg 14(6):384–391. doi: 10.1055/s-2004-821120 PubMedCrossRefGoogle Scholar
  10. 10.
    Guo X, Feng J, Wang G (2008) Anorectal electromanometrical patterns in children with isolated neuronal intestinal dysplasia. Eur J Pediatr Surg 18(3):176–179. doi: 10.1055/s-2008-1038501 PubMedCrossRefGoogle Scholar
  11. 11.
    Meier-Ruge WA, Bruder E, Kapur RP (2006) Intestinal neuronal dysplasia type B: one giant ganglion is not good enough. Pediatr Dev Pathol 9(6):444–452. doi: 10.2350/06-06-0109.1 PubMedCrossRefGoogle Scholar
  12. 12.
    Taguchi T, Masumoto K, Ieiri S, Nakatsuji T, Akiyoshi J (2006) New classification of hypoganglionosis: congenital and acquired hypoganglionosis. J Pediatr Surg 41(12):2046–2051. doi: 10.1016/j.jpedsurg.2006.08.004 PubMedCrossRefGoogle Scholar
  13. 13.
    Zhang HY, Feng JX, Huang L, Wang G, Wei MF, Weng YZ (2008) Diagnosis and surgical treatment of isolated hypoganglionosis. World J Pediatr 4(4):295–300. doi: 10.1007/s12519-008-0053-3 PubMedCrossRefGoogle Scholar
  14. 14.
    Hess R, Scarpelli DG, Pearse AG (1958) The cytochemical localization of oxidative enzymes. II. Pyridine nucleotide-linked dehydrogenases. J Biophys Biochem Cytol 4(6):753–760PubMedCrossRefGoogle Scholar
  15. 15.
    Kobayashi H, Miyahara K, Kusafuka J, Yamataka A, Lane GJ, Sueyoshi N, Miyano T, Puri P (2007) A new rapid acetylcholinesterase staining kit for diagnosing Hirschsprung's disease. Pediatr Surg Int 23(5):505–508. doi: 10.1007/s00383-006-1849-7 PubMedCrossRefGoogle Scholar
  16. 16.
    Staines WA, Bettolli M, De Carli C, Swinton E, Sweeney B, Krantis A, Rubin SZ (2007) Fast evaluation of intraoperative biopsies for ganglia in Hirschsprung's disease. J Pediatr Surg 42(12):2067–2070. doi: 10.1016/j.jpedsurg.2007.08.028 PubMedCrossRefGoogle Scholar
  17. 17.
    Nemeth L, O'Briain S, Puri P (1999) Whole-mount NADPH-diaphorase histochemistry is a reliable technique for the intraoperative evaluation of extent of aganglionosis. Pediatr Surg Int 15(3–4):195–197PubMedCrossRefGoogle Scholar
  18. 18.
    Wang H, Zhang Y, Liu W, Wu R, Chen X, Gu L, Wei B, Gao Y (2009) Interstitial cells of Cajal reduce in number in recto-sigmoid Hirschsprung's disease and total colonic aganglionosis. Neurosci Lett 451(3):208–211. doi: 10.1016/j.neulet.2009.01.015 PubMedCrossRefGoogle Scholar
  19. 19.
    Holschneider AM, Meier-Ruge W, Ure BM (1994) Hirschsprung's disease and allied disorders—a review. Eur J Pediatr Surg 4(5):260–266. doi: 10.1055/s-2008-1066115 PubMedCrossRefGoogle Scholar
  20. 20.
    Meier-Ruge WA, Bruder E (2005) Pathology of chronic constipation in pediatric and adult coloproctology. Pathobiology 72(1–2):1–102PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Ning Li
    • 1
  • Lei Xiang
    • 1
  • Xiaojuan Wu
    • 1
  • Jixin Yang
    • 1
  • Jia Wei
    • 1
  • Jiexiong Feng
    • 1
  1. 1.Department of Pediatric Surgery, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina

Personalised recommendations