Hirschsprung disease is confirmed on rectal suction biopsy. Which histological finding is diagnostic?
- A Decreased mucin production in goblet cells
- B Increased eosinophilic infiltration of the muscularis propria
- C Absence of ganglion cells in Auerbach's (myenteric) and Meissner's (submucosal) plexuses with hypertrophied nerve trunks ✓
- D Crypt distortion and goblet cell depletion
Correct answer: C. Absence of ganglion cells in Auerbach's (myenteric) and Meissner's (submucosal) plexuses with hypertrophied nerve trunks
Explanation
Hirschsprung disease is defined histologically by the absence of ganglion cells (aganglionosis) in both the myenteric (Auerbach's) and submucosal (Meissner's) plexuses of the affected bowel segment, accompanied by hypertrophied extrinsic nerve trunks (seen on acetylcholinesterase staining as dark brown trunks). Rectal suction biopsy is the gold standard diagnostic test; at least three submucosal specimens above the dentate line are needed. Acetylcholinesterase staining enhances sensitivity.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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