Pathological Evaluation of Ganglion Cells in Biopsies from Upper Side of the Dentate Line in Patients with Perianal Problems

Constipation is one of the most common complaints of individuals, which may present with complication like hemorrhoid and fissure. Hirschsprung is a disease presenting with chronic constipation and its diagnosis may be delayed until adulthood. It is diagnosed by biopsies from anorectal transitional zone. This study aimed to evaluate the association between Hirschsprung and anorectal problems. Sixty three patients with anorectal problems who underwent surgery enrolled in this study. Some consecutive biopsies were obtained from anal canal at 2, 4 and 6 cm above the dentate line. Biopsies were assessed for ganglion cells changes. Patient's data and biopsies results were analyzed with SPSS version18. Out of 63 patients 29 (46%) patients were female and 34 (54%) were male with the mean of 32.65±13.73 years. Fifty six (73%) patients complained from constipation with the mean time of 57.65±45.21 months. Aganglionic zones were reported in six patients with the mean length of 43.33 mm. There was not any relation between anal ganglion cells pathology and constipation (P=0.363), but there was a significant relation between duration of constipation and pathologic changes (P=0.001). The ratio of constipation duration to age was related to anal ganglion cell pathology (P=0.001). Hemorrhoid degree was also affected anal ganglion cells pathology (P=0.037). The relation between Hirschsprung's disease and anorectal problems in adults were significant. The pathologic findings were more presented in younger patients, and those with longer history of constipation and lower degree hemorrhoids.