Tag: Hirschsprungs

Categories
Colorectal General

Constipation: biopsy?

Constipation is a common problem in childhood.

Very rarely, an underlying and serious problem i.e. Hirschsprung’s disease, can be detected on biopsy.

Importantly, most biopsies done are actually negative.

However, it can be tricky moving forward with recommended treatments if there is an outstanding concern.

For parents, it can be quite difficult to decide if the time has come to discuss a biopsy with your paediatrician.

Paediatric surgeon’s are best placed to review and advise. We manage Hirschsprung’s disease and will have a good sense of whether a biopsy is needed or not.

Here are some facts about rectal biopsies for constipation.

Categories
Colorectal

Rectal biopsy for constipation: a guide for parents

Constipation is a common problem in childhood. Most children will have an episode that passes naturally, or with changes in diet and perhaps some medication. However, some children will have chronic, ongoing issues that escalate, needing surgical intervention.

When is a biopsy of the rectum useful?

If 10 children have a biopsy, 1 or 2 may have a positive finding of Hirschsprung’s disease.

However, a review will be necessary before the biopsy to find out if there are other risk factors.

NICE recommends that a rectal biopsy should not be performed unless there is:

-delayed meconium (>48hrs after birth in a term baby

-early constipation (first weeks of life)

-chronic abdominal distension plus vomiting

-family history of Hirschsprung’s disease

-faltering growth, in addition to any of the previous features

Other features have been suggested:

–vomiting, in addition to abdominal distension is a risk factor for Hirschsprungs

-a rectal biopsy is more likely to be negative with increasing age

–girls are less likely to have a positive biopsy for Hirschsprung’s

How is the biopsy done?

Suction biopsy: A small , finger-like biopsy tube is placed inside the rectum. A syringe is used to suck some of the rectal tissue into the tube, which has a cutting mechanism. A small sample is pinched off. As the sample is small, the surgeon may choose to take a 2-3 samples at different levels, to increase the chance of a clear result. Most doctors would like to do this under the age of 6 months.

This method can be carried out in an awake baby, as long as can be effectively wrapped to keep them still. Over 6 months, the baby is strong enough to move, making the test more difficult to achieve effectively.

Strip biopsy: This method involves a general anaesthetic. Once asleep, the surgeon looks inside the rectum and cuts out a 1-2cm strip of tissue. 

Regardless of method, these samples are then sent to the lab. 

What are the lab looking for?

In summary, nerve fibres and ganglion cells.

Ganglion cells are specialised hubs where nerve fibres meet and communicate. The histopathologist in the lab looks to confirm the presence of the nerve fibres and ganglion cells.

In Hirschsprung’s disease, there are no ganglion cells (hence the term- aganglionosis) within the bowel layers.

Nerve fibres are absent. Abnormally thickened nerve trunks are also observed.

This ganglion cell test is very sensitive for Hirschsprung’s disease. If the ganglion cells are seen, your surgeon can be >93% sure that your child doe not have Hirschsprung’s disease.

Categories
Corporate

Dr Coates

BA, MA (Oxon), MBBChir (Cantab), PhD, FRCS (Paed)

Dr Eva Coates is a Consultant Paediatric Surgeon at Oxford University Hospitals.

She has a sub-speciality interest, and accreditation, in Paediatric Colorectal Surgery. She has a clinical interest in minimal invasive keyhole surgery, constipation in children, anorectal malformations, Hirschsprung disease and inflammatory bowel disease.

Dr Coates completed medical training at University of Oxford and University of Cambridge. She completed higher surgical training rotations in the South East of England London and Cambridge centres. She holds a PhD from University College London, where she focused on risk stratification for children requiring fundoplication. She successfully completed the Royal College of Surgeons Senior Fellowship in Paediatric Colorectal Surgery.

Dr Coates has multiple publications and presentations covering upper and lower gastrointestinal problems affecting children. She has an ongoing interest in cohort data informatics and patient empowerment through education.


Ages covered: neonate to 16 years

Special interests

Constipation in children: Rectal biopsy, Botox, ACE procedure
Rectal bleeding
Anal fissure
Anal fistula
Haemorrhoids

Pilonidal sinus and abscess

Anorectal malformations
Hirschsprung disease
Inflammatory Bowel Disease Ulcerative Colitis & Crohn’s Disease

General interest

Inguinal hernia
Umbilical hernia
Undescended testis orchidopexy
Foreskin problems, circumcision for scarred phimosis or BXO

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