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Variants of Hirschsprung Disease

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Abstract

Variants of Hirschsprung disease (HD) are a group of conditions that clinically resemble HD despite the presence of ganglion cells in rectal suction biopsies. The characterization and differentiation of various entities is mainly based on histological and immunohistochemical findings of biopsies from patients with functional intestinal obstruction.

Over the last decades, several groups have focused on the investigation and definition of variant HD such as intestinal neuronal dysplasia, isolated hyperganglionosis, internal anal sphincter achalasia, immature ganglia, and smooth muscle cell disorders such as megacystis microcolon intestinal hypoperistalsis syndrome. However, definition of the above-mentioned entities remains a controversial issue and research is ongoing to standardize diagnostic criteria, specific therapy, and outcome criteria.

This chapter summarizes the current knowledge of the above-mentioned entities of variant HD.

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References

  • Berdon WE, Baker DH, Blanc WA, et al. Megacystis-microcolon-intestinal hypoperistalsis syndrome: a new cause of intestinal obstruction in the newborn. Report of radiologic findings in five newborn girls. AJR Am J Roentgenol. 1976;126:957–64.

    Article  CAS  Google Scholar 

  • Bruder E, Meier-Ruge WA. Intestinal neuronal dysplasia type B: how do we understand it today? Pathologe. 2007;28:137–42. https://doi.org/10.1007/s00292-007-0894-x.

    Article  CAS  PubMed  Google Scholar 

  • Ciftci AO, Cook RC, van Velzen D. Megacystis microcolon intestinal hypoperistalsis syndrome: evidence of a primary myocellular defect of contractile fiber synthesis. J Pediatr Surg. 1996;31(12):1706–11.

    Article  CAS  Google Scholar 

  • Coerdt W, Michel JS, Rippin G, et al. Quantitative morphometric analysis of the submucous plexus in age-related control groups. Virchows Arch. 2004;444:239–46. https://doi.org/10.1007/s00428-003-0951-7.

    Article  PubMed  Google Scholar 

  • Costa M, Fava M, Seri M, et al. Evaluation of the HOX11L1 gene as a candidate for congenital disorders of intestinal innervation. J Med Genet. 2000;37:E9–9. https://doi.org/10.1136/jmg.37.7.e9.

    Article  Google Scholar 

  • De Caluwe D, Yoneda A, Akl U, Puri P. Internal anal sphincter achalasia: outcome after internal sphincter myectomy. J Pediatr Surg. 2001;36:736–8.

    Article  Google Scholar 

  • Dingemann J, Puri P. Isolated hypoganglionosis: systematic review of a rare intestinal innervation defect. Pediatr Surg Int. 2010;26:1111–5. https://doi.org/10.1007/s00383-010-2693-3.

    Article  PubMed  Google Scholar 

  • Do MY, Myung SJ, Park HJ, et al. Novel classification and pathogenetic analysis of hypoganglionosis and adult-onset Hirschsprung’s disease. Dig Dis Sci. 2011;56:1818–27. https://doi.org/10.1007/s10620-010-1522-9.

    Article  PubMed  Google Scholar 

  • Doodnath R, Puri P. Internal anal sphincter achalasia. Semin Pediatr Surg. 2009a;18:246–8. https://doi.org/10.1053/j.sempedsurg.2009.07.006.

    Article  PubMed  Google Scholar 

  • Doodnath R, Puri P. Long-term outcome of internal sphincter myectomy in patients with internal anal sphincter achalasia. Pediatr Surg Int. 2009b;25:869–71. https://doi.org/10.1007/s00383-009-2436-5.

    Article  PubMed  Google Scholar 

  • Fadda B, Maier WA, Meier-Ruge W, et al. Neuronal intestinal dysplasia. Critical 10-years’ analysis of clinical and biopsy diagnosis. Z Kinderchir. 1983;38:305–11. https://doi.org/10.1055/s-2008-1059994.

    Article  CAS  PubMed  Google Scholar 

  • Fava M, Borghini S, Cinti R, et al. HOX11L1: a promoter study to evaluate possible expression defects in intestinal motility disorders. Int J Mol Med. 2002;10:101–6.

    CAS  PubMed  Google Scholar 

  • Friedmacher F, Puri P. Comparison of posterior internal anal sphincter myectomy and intrasphincteric botulinum toxin injection for treatment of internal anal sphincter achalasia: a meta-analysis. Pediatr Surg Int. 2012;28:765–71. https://doi.org/10.1007/s00383-012-3123-5.

    Article  PubMed  Google Scholar 

  • Garel C, Dreux S, Philippe-Chomette P, et al. Contribution of fetal magnetic resonance imaging and amniotic fluid digestive enzyme assays to the evaluation of gastrointestinal tract abnormalities. Ultrasound Obstet Gynecol. 2006;28:282–91. https://doi.org/10.1002/uog.2799.

    Article  CAS  PubMed  Google Scholar 

  • Gath R, Goessling A, Keller KM, et al. Analysis of the RET, GDNF, EDN3, and EDNRB genes in patients with intestinal neuronal dysplasia and Hirschsprung disease. Gut. 2001;48:671–5.

    Article  CAS  Google Scholar 

  • Gauthier J, Ouled Amar Bencheikh B, Hamdan FF, Harrison SM, Baker LA, Couture F, et al. A homozygous loss-of-function variant in MYH11 in a case with megacystis-microcolon-intestinal hypoperistalsis syndrome. Eur J Hum Genet. 2015;23(9):1266–8.

    Article  CAS  Google Scholar 

  • Gillick J, Tazawa H, Puri P. Intestinal neuronal dysplasia: results of treatment in 33 patients. J Pediatr Surg. 2001;36:777–9. https://doi.org/10.1053/jpsu.2001.22959.

    Article  CAS  PubMed  Google Scholar 

  • Gosemann J-H, Puri P. Megacystis microcolon intestinal hypoperistalsis syndrome: systematic review of outcome. Pediatr Surg Int. 2011;27:1041–6. https://doi.org/10.1007/s00383-011-2954-9.

    Article  PubMed  Google Scholar 

  • Granata C, Puri P. Megacystis-microcolon-intestinal hypoperistalsis syndrome. J Pediatr Gastroenterol Nutr. 1997;25(1):12–9.

    Article  CAS  Google Scholar 

  • Granero Cendon R, Millan Lopez A, Moya Jimenez MJ, et al. Intestinal neuronal dysplasia: association with digestive malformations. Cir Pediatr. 2007;20:166–8.

    CAS  PubMed  Google Scholar 

  • Halim D, Brosens E, Muller F, Wangler MF, Beaudet AL, Lupski JR, et al. Loss-of-function variants in MYLK cause recessive megacystis microcolon intestinal hypoperistalsis syndrome. Am J Hum Genet. 2017a;101(1):123–9.

    Article  CAS  Google Scholar 

  • Halim D, Hofstra RM, Signorile L, Verdijk RM, van der Werf CS, Sribudiani Y, et al. ACTG2 variants impair actin polymerization in sporadic megacystis microcolon intestinal hypoperistalsis syndrome. Hum Mol Genet. 2016;25(3):571–83.

    Article  CAS  Google Scholar 

  • Halim D, Wilson MP, Oliver D, Brosens E, Verheij JB, Han Y, et al. Loss of LMOD1 impairs smooth muscle cytocontractility and causes megacystis microcolon intestinal hypoperistalsis syndrome in humans and mice. Proc Natl Acad Sci U S A. 2017b;114(13):E2739–47.

    Article  CAS  Google Scholar 

  • Hatano M, Aoki T, Dezawa M, et al. A novel pathogenesis of megacolon in Ncx/Hox11L.1 deficient mice. J Clin Invest. 1997;100:795–801. https://doi.org/10.1172/JCI119593.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hirakawa H, Kobayashi H, O’Briain DS, Puri P. Absence of NADPH-diaphorase activity in internal anal sphincter (IAS) achalasia. J Pediatr Gastroenterol Nutr. 1995;20:54–8.

    Article  CAS  Google Scholar 

  • Holland-Cunz S, Krammer HJ, Suss A, et al. Molecular genetics of colorectal motility disorders. Eur J Pediatr Surg. 2003;13:146–51. https://doi.org/10.1055/s-2003-41767.

    Article  CAS  PubMed  Google Scholar 

  • Holschneider AM, Puri P, Homrighausen LH, Meier-Ruge W. Intestinal neuronal malformations (IND): clinical experience and treatment. In: Holschneider AM, Puri P, editors. Hirschsprung’s disease and allied disorders. Heidelberg: Springer; 2008. p. 229–51.

    Chapter  Google Scholar 

  • Inoue K, Shimotake T, Tomiyama H, Iwai N. Mutational analysis of the RET and GDNF gene in children with hypoganglionosis. Eur J Pediatr Surg. 2001;11:120–3. https://doi.org/10.1055/s-2001-13792.

    Article  CAS  PubMed  Google Scholar 

  • Jona JZ, Werlin SL. The megacystis microcolon intestinal hypoperistalsis syndrome: report of a case. J Pediatr Surg. 1981;16(5):749–51.

    Article  CAS  Google Scholar 

  • Knowles CH, De Giorgio R, Kapur RP, et al. The London Classification of gastrointestinal neuromuscular pathology: report on behalf of the Gastro 2009 International Working Group. 2010. p 882–7.

    Article  Google Scholar 

  • Kobayashi H, Hirakawa H, Surana R, et al. Intestinal neuronal dysplasia is a possible cause of persistent bowel symptoms after pull-through operation for Hirschsprungs-disease. J Pediatr Surg. 1995;30:253–9.

    Article  CAS  Google Scholar 

  • Kobayashi H, Mahomed A, Puri P. Intestinal neuronal dysplasia in twins. J Pediatr Gastroenterol Nutr. 1996;22:398–401.

    Article  CAS  Google Scholar 

  • Kohler M, Pease PW, Upadhyay V. Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) in siblings: case report and review of the literature. Eur J Pediatr Surg. 2004;14(5):362–7.

    Article  Google Scholar 

  • Koletzko S, Jesch I, Faus-Kebetaler T, et al. Rectal biopsy for diagnosis of intestinal neuronal dysplasia in children: a prospective multicentre study on interobserver variation and clinical outcome. Gut. 1999;44:853–61.

    Article  CAS  Google Scholar 

  • Korğalı EÜ, Yavuz A, Şimşek CEÇ, Güney C, Kurtulgan HK, Başer B, et al. Megacystis microcolon intestinal hypoperistalsis syndrome in which a different De Novo Actg2 gene mutation was detected: a case report. Fetal Pediatr Pathol. 2018;37(2):109–16.

    Article  Google Scholar 

  • Kubota M, Ikeda K, Ito Y. Autonomic innervation of the intestine from a baby with megacystis microcolon intestinal hypoperistalsis syndrome: II. Electrophysiological study. J Pediatr Surg. 1989;24(12):1267–70.

    Article  CAS  Google Scholar 

  • Lake BD. Intestinal neuronal dysplasia. Why does it only occur in parts of Europe? Virchows Arch. 1995;426:537–9.

    Article  CAS  Google Scholar 

  • Lake BD, Puri P, Nixon HH, Claireaux AE. Hirschsprung’s disease: an appraisal of histochemically demonstrated acetylcholinesterase activity in suction rectal biopsy specimens as an aid to diagnosis. Arch Pathol Lab Med. 1978;102:244–7.

    CAS  PubMed  Google Scholar 

  • Loinaz C, Rodriguez MM, Kato T, Mittal N, Romaguera RL, Bruce JH, et al. Intestinal and multivisceral transplantation in children with severe gastrointestinal dysmotility. J Pediatr Surg. 2005;40(10):1598–604.

    Article  Google Scholar 

  • Martucciello G, Torre M, Pini Prato A, et al. Associated anomalies in intestinal neuronal dysplasia. J Pediatr Surg. 2002;37:219–23.

    Article  CAS  Google Scholar 

  • Martucciello G, Pini Prato A, Puri P, et al. Controversies concerning diagnostic guidelines for anomalies of the enteric nervous system: a report from the fourth international symposium on Hirschsprung’s disease and related neurocristopathies. In: 2005 edn. 2005. p 1527–31.

    Google Scholar 

  • McNamara HM, Onwude JL, Thornton JG. Megacystis-microcolon-intestinal hypoperistalsis syndrome: a case report supporting autosomal recessive inheritance. Prenat Diagn. 1994;14:153–4.

    Article  CAS  Google Scholar 

  • McLaughlin D, Puri P. Familial megacystis microcolon intestinal hypoperistalsis syndrome: a systematic review. Pediatr Surg Int 2013;29:947–951.

    Article  Google Scholar 

  • Meier-Ruge WA. Casuistic colon disorder with symptoms of Hirschsprung’s disease. Verh Dtsch Ges Pathol. 1971;55:506–10.

    CAS  PubMed  Google Scholar 

  • Meier-Ruge W. Ultrashort segment Hirschsprung disease. An objective picture of the disease substantiated by biopsy. Z Kinderchir. 1985;40:146–50. https://doi.org/10.1055/s-2008-1059734.

    Article  CAS  PubMed  Google Scholar 

  • Meier-Ruge W. Epidemiology of congenital innervation defects of the distal colon. Virchows Arch A Pathol Anat Histopathol. 1992;420:171–7.

    Article  CAS  Google Scholar 

  • Meier-Ruge WA, Bruder E. Pathology of chronic constipation in pediatric and adult coloproctology. Pathobiology. 2005;72:1–102.

    Article  Google Scholar 

  • Meier-Ruge WA, Brunner LA, Engert J, et al. A correlative morphometric and clinical investigation of hypoganglionosis of the colon in children. Eur J Pediatr Surg. 1999;9:67–74. https://doi.org/10.1055/s-2008-1072216.

    Article  CAS  PubMed  Google Scholar 

  • Meier-Ruge WA, Ammann K, Bruder E, et al. Updated results on intestinal neuronal dysplasia (IND B). Eur J Pediatr Surg. 2004;14:384–91. https://doi.org/10.1055/s-2004-821120.

    Article  CAS  PubMed  Google Scholar 

  • Milla PJ, Smith VV. Intestinal neuronal dysplasia. J Pediatr Gastroenterol Nutr. 1993;17:356–7.

    Article  CAS  Google Scholar 

  • Montedonico S, Acevedo S, Fadda B. Clinical aspects of intestinal neuronal dysplasia. J Pediatr Surg. 2002;37:1772–4. https://doi.org/10.1053/jpsu.2002.36720.

    Article  PubMed  Google Scholar 

  • Montedonico S, Caceres P, Munoz N, et al. Histochemical staining for intestinal dysganglionosis: over 30 years experience with more than 1,500 biopsies. Pediatr Surg Int. 2011;27:479–86. https://doi.org/10.1007/s00383-010-2849-1.

    Article  PubMed  Google Scholar 

  • Moore SW. Advances in understanding functional variations in the Hirschsprung disease spectrum (variant Hirschsprung disease). Pediatr Surg Int. 2016; https://doi.org/10.1007/s00383-016-4038-3.

    Article  PubMed  Google Scholar 

  • Moore SW, Kaschula ROC, Cywes S. Familial and genetic-aspects of neuronal intestinal dysplasia and Hirschsprungs-disease. Pediatr Surg Int. 1993;8:406–9.

    Article  Google Scholar 

  • Nakamura H, O’Donnell AM, Puri P. Consanguinity and its relevance for the incidence of megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS): systematic review. Pediatr Surg Int. 2019;35:175–180.

    Article  Google Scholar 

  • Neilson IR, Yazbeck S. Ultrashort Hirschsprung’s disease: myth or reality. J Pediatr Surg. 1990;25:1135–8.

    Article  CAS  Google Scholar 

  • Oue T, Puri P. Altered intramuscular innervation and synapse formation in internal sphincter achalasia. Pediatr Surg Int. 1999;15:192–4.

    Article  CAS  Google Scholar 

  • Penman DG, Lilford RJ. The megacystis-microcolon-intestinal hypoperistalsis syndrome: a fatal autosomal recessive condition. J Med Genet. 1989;26:66–7.

    Article  CAS  Google Scholar 

  • Pini Prato A, Rossi V, Fiore M, et al. Megacystis, megacolon, and malrotation: a new syndromic association? Am J Med Genet A. 2011;155A:1798–802. https://doi.org/10.1002/ajmg.a.34119.

    Article  CAS  PubMed  Google Scholar 

  • Piotrowska AP, Solari V, Puri P. Distribution of interstitial cells of Cajal in the internal anal sphincter of patients with internal anal sphincter achalasia and Hirschsprung disease. Arch Pathol Lab Med. 2003;127:1192–5. https://doi.org/10.1043/1543-2165(2003)127<1192:DOICOC>2.0.CO;2.

    Article  PubMed  Google Scholar 

  • Puri P. Intestinal dysganglionosis and other disorders of intestinal motility. In: Coran AG, Adzick NS, Krummel TM, et al. editors. Pediatric surgery. 7th ed. Philadelphia: Elsevier Saunders; 2012. p. 1279–87.

    Chapter  Google Scholar 

  • Puri P, Fujimoto T. Diagnosis of allied functional bowel disorders using monoclonal antibodies and electronmicroscopy. J Pediatr Surg. 1988;23:546–54.

    Article  CAS  Google Scholar 

  • Puri P, Gosemann J-H. Megacystis microcolon intestinal hypoperistalsis syndrome. In: Puri P, editor. Newborn surgery. 3rd ed. London: Hodder Arnold; 2011. p. 615–20.

    Chapter  Google Scholar 

  • Puri P, Gosemann J-H. Variants of Hirschsprung disease. Semin Pediatr Surg. 2012;21:310–8. https://doi.org/10.1053/j.sempedsurg.2012.07.005.

    Article  PubMed  Google Scholar 

  • Puri P, Lake BD, Nixon HH, et al. Neuronal colonic dysplasia: an unusual association of Hirschsprung’s disease. J Pediatr Surg. 1977;12:681–5.

    Article  CAS  Google Scholar 

  • Puri P, Lake BD, Gorman F, et al. Megacystis-microcolon-intestinal hypoperistalsis syndrome: a visceral myopathy. J Pediatr Surg. 1983;18:64–9.

    Article  CAS  Google Scholar 

  • Richardson CE, Morgan JM, Jasani B, Green JT, Rhodes J, Williams GT, et al. Megacystis-microcolon-intestinal hypoperistalsis syndrome and the absence of the alpha3 nicotinic acetylcholine receptor subunit. Gastroenterology. 2001;121(2):350–7.

    Article  CAS  Google Scholar 

  • Rolle U, O’Briain S, Pearl RH, Puri P. Megacystis-microcolon-intestinal hypoperistalsis syndrome: evidence of intestinal myopathy. Pediatr Surg Int. 2002;18:2–5. https://doi.org/10.1007/s003830200001.

    Article  PubMed  Google Scholar 

  • Sacher P, Briner J, Hanimann B. Is neuronal intestinal dysplasia (NID) a primary disease or a secondary phenomenon? Eur J Pediatr Surg. 1993;3:228–30. https://doi.org/10.1055/s-2008-1063549.

    Article  CAS  PubMed  Google Scholar 

  • Schäppi MG, Staiano A, Milla PJ, et al. A practical guide for the diagnosis of primary enteric nervous system disorders. J Pediatr Gastroenterol Nutr. 2013;57:677–86. https://doi.org/10.1097/MPG.0b013e3182a8bb50.

    Article  PubMed  Google Scholar 

  • Shirasawa S, Yunker AM, Roth KA, et al. Enx (Hox11L1)-deficient mice develop myenteric neuronal hyperplasia and megacolon. Nat Med. 1997;3:646–50.

    Article  CAS  Google Scholar 

  • Swaminathan M, Kapur RP. Counting myenteric ganglion cells in histologic sections: an empirical approach. Hum Pathol. 2010;41:1097–108. https://doi.org/10.1016/j.humpath.2009.12.012.

    Article  PubMed  Google Scholar 

  • Taguchi T, Ikeda K, Shono T, Goto S, Kubota M, Kawana T, et al. Autonomic innervation of the intestine from a baby with megacystis microcolon intestinal hypoperistalsis syndrome: I. Immunohistochemical study. J Pediatr Surg. 1989;24(12):1264–6.

    Article  CAS  Google Scholar 

  • Thorson W, Diaz-Horta O, Foster J 2nd, Spiliopoulos M, Quintero R, Farooq A, et al. De novo ACTG2 mutations cause congenital distended bladder, microcolon, and intestinal hypoperistalsis. Hum Genet. 2014;133(6):737–42.

    Article  CAS  Google Scholar 

  • Tuzovic L, Tang S, Miller RS, Rohena L, Shahmirzadi L, Gonzalez K, et al. New insights into the genetics of fetal megacystis: ACTG2 mutations, encoding gamma-2 smooth muscle actin in megacystis microcolon intestinal hypoperistalsis syndrome (Berdon Syndrome). Fetal Diagn Ther. 2015;38(4):296–306.

    Article  Google Scholar 

  • Ure BM, Holschneider AM, Schulten D, Meier-Ruge W. Clinical impact of intestinal neuronal malformations: a prospective study in 141 patients. Pediatr Surg Int. 1997;12:377–82.

    Article  CAS  Google Scholar 

  • von Boyen GB, Krammer HJ, Suss A, et al. Abnormalities of the enteric nervous system in heterozygous endothelin B receptor deficient (spotting lethal) rats resembling intestinal neuronal dysplasia. Gut. 2002;51:414–9.

    Article  Google Scholar 

  • Wangler MF, Gonzaga-Jauregui C, Gambin T, Penney S, Moss T, Chopra A, et al. Heterozygous de novo and inherited mutations in the smooth muscle actin (ACTG2) gene underlie megacystis-microcolon-intestinal hypoperistalsis syndrome. PLoS Genet. 2014;10(3):e1004258.

    Article  Google Scholar 

  • Wester T, O’Briain DS, Puri P. Notable postnatal alterations in the myenteric plexus of normal human bowel. Gut. 1999;44:666–74.

    Article  CAS  Google Scholar 

  • Xu W, Gelber S, Orr-Urtreger A, Armstrong D, Lewis RA, Ou CN, et al. Megacystis, mydriasis, and ion channel defect in mice lacking the alpha3 neuronal nicotinic acetylcholine receptor. Proc Natl Acad Sci USA. 1999;96(10):5746–51.

    Article  CAS  Google Scholar 

  • Young ID, McKeever PA, Brown LA, Lang GD. Prenatal diagnosis of the megacystis-microcolon-intestinal hypoperistalsis syndrome. J Med Genet. 1989;26:403–6.

    Article  CAS  Google Scholar 

  • Young LW, Yunis EJ, Girdany BR, Sieber WK. Megacystis-microcolon-intestinal hypoperistalsis syndrome: additional clinical, radiologic, surgical, and histopathologic aspects. AJR Am J Roentgenol. 1981;137(4):749–55.

    Article  CAS  Google Scholar 

  • Zhang HY, Feng JX, Huang L, et al. Diagnosis and surgical treatment of isolated hypoganglionosis. World J Pediatr. 2008;4:295–300. https://doi.org/10.1007/s12519-008-0053-3.

    Article  CAS  PubMed  Google Scholar 

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  1. National Children’s Research Centre, Our Lady’s Children’s Hospital, Dublin 12, Ireland

    Prem Puri & Hiroki Nakamura

  2. School of Medicine and Medical Science and Conway Institute of Biomedical Research, University College Dublin, Dublin 12, Ireland

    Prem Puri

  3. Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany

    Jan-Hendrik Gosemann

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  1. Our Lady’s Children's Hospital, National Children’s Research Centre, Dublin, Ireland

    Prem Puri

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Puri, P., Gosemann, JH., Nakamura, H. (2019). Variants of Hirschsprung Disease. In: Puri, P. (eds) Pediatric Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38482-0_75-2

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    Variants of Hirschsprung Disease
    Published:
    25 April 2019

    DOI: https://doi.org/10.1007/978-3-642-38482-0_75-2

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    Variants of Hirschsprung Disease
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    29 April 2017

    DOI: https://doi.org/10.1007/978-3-642-38482-0_75-1

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