WOFAPS 2025 8th World Congress of Pediatric Surgery

Mehrdad Hosseinpour ¹, Maryam Soltan ², Mohammad Javad Yazdani ²

¹ Isfahan University of Medical Sciences,Departement of Pediatric Surgery,Isfahan, Iran
² Isfahan University of Medical Sciences

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Purpose:

The diagnostic utility of the appendix in Hirschsprung’s disease (HD), particularly total colonic aganglionosis (TCA), remains contentious due to inconsistencies in ganglion cell representation across its structure. This prospective cohort study evaluates the regional distribution of ganglion cells within the appendix to ascertain optimal biopsy localization and enhance diagnostic yield.

Methods:

In a one-year prospective analysis, appendiceal specimens from 100 pediatric patients (≤16 years) undergoing appendectomy for presumed acute appendicitis were histologically assessed. Each specimen was divided into proximal, middle, and distal thirds. The number of ganglion cells per high-power field (hpf) was quantified across all segments using standardized H&E staining and evaluated under blinded pathological review. Repeated measures ANOVA with Greenhouse-Geisser correction was used to assess segmental variability.

Results:

The mean age of the cohort was 8.84 ± 3.33 years; 58% were male. Quantitative analysis revealed a statistically significant regional difference in ganglion cell density (P = 0.038 total count; P = 0.026 per hpf ratio). The middle third demonstrated the highest mean ganglion cell count per hpf (0.87 ± 1.24), surpassing the proximal (0.83 ± 1.21) and distal (0.78 ± 1.04) segments.

Conclusion:

Ganglion cell distribution in the pediatric appendix is not uniform. The middle third exhibits the highest ganglion cell density, making it the most reliable region for histologic sampling. These findings provide anatomical rationale for targeted appendiceal biopsy in the diagnostic algorithm for HD and may reduce reliance on full-thickness or rectal suction biopsies in equivocal or resource-limited scenarios.