CONGENITAL MEGACOLON (HIRSCHSPRUNG'S DISEASE)

A NEW concept of the pathology and surgical treatment of congenital megacolon has been published. The pathology was described as absence of ganglion cells in Auerbach's plexus in the rectosigmoid and rectum. This segmental congenital defect in the myenteric plexus was postulated to account for the absence of peristalsis in the distal colon. Surgical resection of the functionally defective bowel relieved these patients. The following clinical experiences and experiments sustain this concept. Colostomy above the rectosigmoid in four patients with congenital megacolon relieved abdominal distention and colonic stasis. Six months after colostomy closure, these four patients, in whom rectosigmoid resection was not performed, suffered a complete recurrence of the disease. Reopening the colostomy in these patients again relieved all their symptoms with return of the colon to approximately normal size. The dilatation and hypertrophy of the colon seem to have been secondary to a functional obstruction in the rectum and rectosigmoid. Tracings of large bowel peristalsis were made to determine the nature of the rectosigmoid dysfunction. Three small rubber tubes with balloons attached were inserted through a transverse colostomy and positioned so that one balloon was at the splenic flexure, one in the descending colon, and one in the rectosigmoid. The balloons were inflated with 10 cc. of air and attached to recording manometers. Normal recordings were secured from two patients who had transverse colostomy as a result of right colectomy for gangrenous intussusception. The kymograph tracings showed a progression of the peristaltic waves from the transverse colon to the anus.