The Junction Between the Peristaltic and Non-peristaltic Bowel (Shore Break) is Found in the Transition Zone in Hirschsprung's Disease

Yoshitomo Yasui; Miori Kido; Kiyokuni Nakamura; Tsuyoshi Kuwahara; Taichi Hirotani; Ryo Tamura; Motona Kumagai; Miyako Shimasaki; Sohsuke Yamada; Hideaki Okajima

doi:10.1016/j.jpedsurg.2023.05.019

The Junction Between the Peristaltic and Non-peristaltic Bowel (Shore Break) is Found in the Transition Zone in Hirschsprung's Disease

J Pediatr Surg. 2023 Nov;58(11):2160-2164. doi: 10.1016/j.jpedsurg.2023.05.019. Epub 2023 May 31.

Affiliations

¹ Department of Pediatric Surgery, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun, Uchinada, Ishikawa, 920-0293, Japan. Electronic address: yoshitom@kanazawa-med.ac.jp.
² Department of Pediatric Surgery, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun, Uchinada, Ishikawa, 920-0293, Japan.
³ Department of Pathology 2, 1-1 Daigaku, Kahoku-gun, Uchinada, Ishikawa, 920-0293, Japan.
⁴ Department of Clinical Pathology, 1-1 Daigaku, Kahoku-gun, Uchinada, Ishikawa, 920-0293, Japan.

PMID: 37349218
DOI: 10.1016/j.jpedsurg.2023.05.019

Abstract

Background: The junction between the peristaltic and non-peristaltic bowel, which is named the "shore break" (SB), observed on endoscopy is thought to be the boundary between normal and abnormal motility in Hirschsprung's disease (HD). The transition zone (TZ), which is the histopathological border, does not have normal motility and should be resected. This study aimed to evaluate the histopathological findings of the SB and determine the association between the SB and TZ.

Methods: A retrospective review of surgical specimens of patients with HD who underwent preoperative SB marking was conducted. The TZ was defined if nerve hypertrophy, myenteric hypoganglionosis, or partial circumferential aganglionosis was detected.

Results: Ten patients (9 boys and 1 girl) were studied. The median age at surgery was 30 days. The median distance from the anal verge to the marked SB site was 14 cm. No patients manifested any obstructive symptoms resulting from a residual TZ bowel. In eight patients, nerve hypertrophy was identified at the proximal margin and at the SB. Myenteric hypoganglionosis was identified in three patients at the proximal margin and SB. Partial circumferential aganglionosis was identified at the SB in two patients. As a result, in all patients, the pull-through site and SB site had histopathological features indicating TZ.

Conclusions: The SB is located in the TZ. Our results suggest that the proximal part of the TZ has normal motility and that functional border points may be present in the TZ.

Level of evidence: IV.

Keywords: Gastrointestinal motility; Hirschsprung's disease; Transition zone.