Hirschsprung’s disease – Our experience to detect it on table using rapid acetylcholine esterase staining method in a resource restricted tertiary care hospital setup

Background and objective: Hirschsprung’s disease is a disease that occurs in a newborn child with an incidence of one in 5000 live births with a male predominance. In our setup for the diagnosis of Hirshcsprung’s disease, haematoxylin and eosin staining in a formalin fixed tissue was routinely practiced. As a novel diagnostic procedure, rapid on table acetylcholine esterase stain was tried. It is a diagnostic accuracy test done with the following objectives: 1.To perform acetylcholine esterase and rapid hematoxylin and eosin staining in the frozen section of rectal biopsy as a part of intra operative consultation. 2 To correlate routine formalin fixed, hematoxylin and eosin staining results with rapid methods. 3. Feasibility of these procedures in our setup. Method: All infants who had not passed meconium since birth and who had symptoms of intestinal obstruction were screened by pediatric surgeons. As a part of intra-operative consultation, both frozen section and formalin fixation were done in the received specimen. In the frozen section, acetylcholine esterase staining and rapid haematoxylin and eosin staining was done. In the formalin fixed specimen routine haematoxylin and eosin was done. Results: All the three stains- acetylcholine esterase, rapid hematoxylin and eosin and hematoxylin and eosin in a formalin fixed specimens gave equal results. When rapid methods were compared with the routine formalin fixed specimen haematoxylin and eosin staining method the turnaround time was very much reduced. By rapid staining, intra-operative consultation facilitated single stage Duhamel pull- through. Repeat surgery was avoided as both the diagnosis and the level of colon having ganglion cells were assessed simultaneously. As a result, hospital stay was reduced. Conclusion: In this diagnostic study done on twenty cases of suspected Hirschsprung’s disease, the diagnostic efficacy of rapid methods correlated with that of the routinely processed tissue sections stained with haematoxylin and eosin. The turnsaround time for the rapid tests were less. This facilitated on table diagnosis, reduced the need for repeat surgery, improved the outcome of surgery and, there by reduced the duration of hospital stay.