Enterocolitis in Hirschsprung Disease: Update Course 2015

A patulous anus can be identified by observation; Hirschsprung anus should be a normal appearing anus with a normal anal canal.

In anorectal malformations, MRI is used to assess placement of the anus within the sphincters, whereas in Hirschsprung disease the dissection goes right through the sphincter and anal canal without placing the anus.

Jason goes approximately 1 centimeter above the dentate line for anal-rectal dissection in Hirschsprung disease.

A dissection distance of 1 centimeter in a newborn might become 2.5 or 3 centimeters when the child is 7 years old, potentially creating what some would call short segment or ultra short segment Hirschsprung disease.

If the dissection is not high enough and a biopsy is taken, it might show transition zone tissue.

Injury to the dentate line can render patients fecally incontinent, which is a devastating injury.

One surgeon goes 1 centimeter or slightly less above the top of the anal columns.

Jason defines the dentate line as the transition of columnar epithelium, the transition from squamous epithelium to columnar epithelium.

Jason uses the columns as a landmark, going 1 centimeter above the line where the transition from squamous to columnar epithelium is visible.

In J pouch procedures for ulcerative colitis or FAP patients, Jason goes right at the top of the columns, or may hedge lower if polyps are present in that region.

The distance from anoderm to the top of the columns grows with the patient but is almost always the same in newborns.

The dentate line (also called the pectinate line) is pointed to variably in anatomic illustrations and dissections from different sources.

Jason defines the dentate line as the transition from squamous to columnar epithelium, which is where the bottom of the columns lie.

Belinda uses the tops of the columns as a standard landmark for dissection level.

One surgical approach goes to the top of the columns, deliberately leaving a zone of aganglionosis, reasoning that this can be overcome with laxatives whereas fecal incontinence cannot be overcome.

Jason's approach hedges on the side of leaving an ultra short segment Hirschsprung disease versus injuring the anal canal.