[Biopsy of the rectal mucosa in pediatric surgery. Technic--diagnostic value. Apropos of 193 biopsies].
193 series of punch biopsy of the rectal mucosa for the diagnosis of Hirschsprung's disease using the histochemical method are reported. These biopsies concern 176 children from 4 days to twelve years old. The authors insist on the simplicity of the method which requires few equipment: nasal speculum and biopsy forceps. The pieces are carried fresh to the laboratory and treated immediately. The method uses the medium described by Karnovsky and Roots but enzymatic inhibitor of the non selective esterase activity is not used. This shortens the time of the manipulation to about 1 h 30 and limits its cost and toxicity. Three histologists have studied the slides without knowing the clinical facts. Of 36 children suffering from a Hirschsprung's disease all presented a mucosal AChE increased activity, 28 times at once, 8 times after further biopsies. In four patients there was an inadequate biopsy at the beginning of the experience, the other four were very young (less than 1 month). The biopsy was negative at the beginning but it became positive when the patients were about aged 3 months. In the 138 children not suffering of a Hirschsprung's disease, 2 had a AChE increased activity, One is a children suffering from a severe ganglionic displasia obvious on the surgical piece, the other is a colonic mucosal neuromatosis. So, the authors confirm the reliability of the simplified method which required an unsophisticated equipment and whose technique is faster looking for mucosal AChE increased activity and not for the ganglionic cells of the sub-mucosa.(ABSTRACT TRUNCATED AT 250 WORDS)