Investigation of the Distribution of Ganglion Cells in the Appendix According to Location: A Cohort Study

Abstract

Background: Hirschsprung's disease (HD) is a congenital absence of ganglion cells. Due to the lack of consensus about the possibility of relying on the histology of the appendix to diagnose HD, appendectomy and sampling of the appendix are still performed in many centers in Iran and the world to diagnose it. This study aimed to evaluate the possibility of partial appendectomy and prevent total appendectomy to diagnose HD and determine the prevalence of aganglionosis in each part. Methods: The present study was a prospective cohort study. The study population consisted of patients under 16 years of age in need of appendectomy who were referred to Isfahan teaching hospitals from March 2022 to March 2023. The inclusion criteria were age below 16 years and undergoing appendectomy with the diagnosis of appendicitis based on the Alvarado criteria, and the exclusion criteria were perforated or gangrene appendix and appendix neoplasia. The research variables included age and gender (as background variables) and the number of ganglion cells in each hpf (as dependent variable). Findings: The average age of the examined patients was 8.84 ± 3.33 years. 58 of the patients were male. The total number of ganglion cells seen in the entire slide containing the samples was the highest in the middle and the lowest in the distal slides, which were significantly different (P = 0.038). Conclusion: The middle part of the appendix has the highest number of ganglion cells and is the best part fo biopsy for the HD diagnosis. © 2024 Isfahan University of Medical Sciences(IUMS). All rights reserved.