title: 'Hop the skip' with extended segment intestinal biopsy in Hirschsprung's disease.
abstract: BACKGROUND
  Skip segment Hirschsprung's is an extremely rare condition, with only 25 reported cases in the English language literature. Diagnosis of skip segment Hirschsprung's may be missed as it is rarely suspected at initial surgery.
  
  
  METHODS
  A case report of an infant with total colonic aganglionosis and a skip segment Hirschsprung's in the cecum is presented. A review of literature on current surgical practice is presented along with our suggested modification to the diagnostic and therapeutic algorithm of this rare condition.
  
  
  CONCLUSIONS
  In our patient the initial leveling colostomy was incorrectly sited at the level of the first detected ganglionated segment. Subsequent recurrent episodes of enterocolitis led to a diagnosis of a long skip segment involving the ascending colon, cecum and terminal ileum. Correct leveling colostomy and a subsequent Duhamel procedure led to a good outcome.
  
  
  CONCLUSIONS
  Determination of the transition zone in Hirschsprung's may be incorrect if intestinal biopsies are terminated at the first evidence of ganglion cells. Extended segment intestinal biopsies should be included in the algorithm for management of long segment Hirschsprung's disease and will enable the surgeon to correctly detect rare manifestations such as skip segment disease at the initial procedure.
authors.affiliation: Maimonides Medical Center, Division of Pediatric Surgery, Department of Surgery, 921 49th St, USA.
authors.forename: Sathyaprasad
authors.initials: S
authors.lastname: Burjonrappa
authors.forename: Linda
authors.initials: L
authors.lastname: Rankin