hirschsprung’s disease in a twin neonate with one suffering from multiple skip segments

This is a new case, affecting a twin that both with hirschsprung’s disease, one was suffering from long-segment hirschsprung’s disease with skip segmented. our surgeon suspected the absence of abnormal vessel tortuosity in the transitional zone; thus, the appendix was sent for permanent pathology. there were ganglion cells in the colostomy site but no ganglion was found in the appendix. complete biopsies from different parts of the intestine demonstrated positive ganglion cells in the transverse colon, ascending colon, and the distal ileum, jejunum, and duodenum, and negative ganglion cells in the rectum, sigmoid, descending colon, appendix, and 5 cm far from the ileocecal valve were observed. therefore, the kimura procedure was done. the most important key in such cases is the surgeons’ observation during operation.