A term male newborn with distal intestinal obstruction was initially diagnosed with total colonic aganglionosis and received an ileostomy. At 30 months, repeat imaging and biopsies identified an intervening ganglionated segment, allowing a revised pull-through operation tailored to the actual anatomy.
Key findings
- Initial frozen and permanent sections reported absent ganglion cells. Reassessment showed a splenic-flexure transition zone and ganglion cells in the ascending colon, while final mapping described aganglionosis in rectal, descending, and transverse segments with a ganglionated sigmoid segment, consistent with rare skip-segment disease.
Why this matters globally
Over- or under-resection can have lifelong consequences. This report adds a reference case for pediatric surgeons and pathologists, emphasizing that aganglionosis may be discontinuous and that imaging should be reconciled with systematic biopsy mapping.
Thai researcher contribution
Pediatric surgery and pathology teams at Chulalongkorn University and King Chulalongkorn Memorial Hospital documented diagnostic reassessment and surgical adaptation in a rare Thai case.
Limitations to consider
This is one patient, and long-term postoperative outcomes are not provided in the abstract. Differences between initial and later biopsies may reflect sampling location, interpretation, or complex biology. The report cannot replace standard protocols or specialist multidisciplinary assessment.