Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns -

"Suction rectal biopsy is the gold standard for making the diagnosis. There is a normal paucity of ganglia in the region of the internal sphincter; therefore the biopsy should be taken at least 1–2 cm above the dentate line. Acetylcholinesterase staining will demonstrate hypertrophied nerve trunks and a lack of normal ganglia in classical HD. Loss of calretinin immunostaining is also consistent with the diagnosis of HD [23]."

quote from "Pediatric Colorectal Conundrums: Case Studies: From Fundamental to Advanced (Pediatric Colorectal Surgery)" by Marc Levitt, Thomas Xu, Hussein Wissanji -

"During the operation for HD, frozen section biopsies are used. Frozen section biopsies cannot diagnose HD, but they can rule it out. They only capture one section of the bowel and may be useful intraoperatively for confirming the presence of ganglionated bowel for an anastomosis or a stoma site. Permanent sections are the gold standard for diagnosis and are used to determine transition zones. As previously mentioned, the distribution of ganglion cells is irregular at the transition zone, and multiple slices (>100) need to be evaluated circumferentially as a single slice could capture one of the few ganglion cells within a transition zone and falsely lead to a diagnosis of normal colon or the reverse could occur. Frozen section might not see ganglion cells which in fact are nearby, and have the clinician draw the wrong conclusion that the bowel is aganglionic. Frozen section is subject to artifact from cracking of the tissue and can lead to the pathologist not being able to see ganglion cells which are in fact present. Permanent sections also offer a better appreciation and measurement of nerve hypertrophy. They take a longer time to process and are not available intraoperatively"

quote from "Pediatric Colorectal Conundrums: Case Studies: From Fundamental to Advanced (Pediatric Colorectal Surgery)" by Marc Levitt, Thomas Xu, Hussein Wissanji -

"If the frozen section reveals active enterocolitis in a ganglionated bowel section without nerve hypertrophy, diversion should be considered as active enterocolitis can increase the risk of anastomotic complications such as stricture and dehiscence."

On 4/2/2026 at 3:38 PM, admin said:

quote from "Pediatric Colorectal Conundrums: Case Studies: From Fundamental to Advanced (Pediatric Colorectal Surgery)" by Marc Levitt, Thomas Xu, Hussein Wissanji -

"If the frozen section reveals active enterocolitis in a ganglionated bowel section without nerve hypertrophy, diversion should be considered as active enterocolitis can increase the risk of anastomotic complications such as stricture and dehiscence."

Teach The Mother How to Perform Rectal Irrigation with Flageal Pre- and Post- Pull-Through,If Failed Diversion?