The K-Punch Method: An Effective Diagnostic Approach for Hirschsprung Disease in Low- and Middle-Income Countries - A Case Series

Introduction:  Congenital intestinal aganglionosis (Hirschsprung’s disease - HD) is characterized by the absence of intramural parasympathetic ganglion cells in the submucosal and muscular layers of the intestinal wall, predominantly affecting the recto-sigmoid and determining functional intestinal obstruction. Rectal biopsy is the gold standard for diagnosis, and there are several techniques available for obtaining samples. Limitations related to cost, equipment maintenance and access to biopsy instruments have hindered the implementation of minimally invasive aspiration biopsies in Brazil. This study aims to evaluate the performance of the K punch method (MKP) as a minimal invasion and low cost alternative in obtaining submucosal rectal samples for histopathological analysis in the investigation of HD.

Methods:  Retrospective analysis of a 25 pediatric patients´ cohort, which has been submitted to histological evaluation for HD using the MKP biopsy method.

Results:  The samples were suitable for histological analysis aiming at the diagnosis of HD in 24 cases (96%). One patient needed to repeat the procedure due to the insufficiency of the fragment obtained. A mild complication (self-limited bleeding) was observed, without the need for additional intervention (Clavien-Dindo 1).

Conclusion:  The results suggest that the MCK technique can provide adequate rectal submucosal samples for histological analysis towards the diagnosis of HD, and may be applicable in different health care contexts.

Keywords:
Colonic Aganglionosis; Histology, Diagnosis; Biopsy; Intestinal Obstruction; Constipation; Megacolon; Cohort Study