Reoperated Congenital Megacolon

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THE study of the pathology of congenital megacolon by Whitehouse and Kernohan1 and Swenson's physiologic and surgical studies2–4 form a logical approach to adequate therapy of the disorder best known as congenital megacolon or Hirschsprung's disease.5 We viewed with some misgivings the recent report of State6 who advocated retention of the major portion of the rectum as part of the surgical correction of this disorder.

We have recently encountered a case in which the distal sigmoid and rectum containing an aganglionic segment had been retained, and reoperation was required.


Clinical Features

The patient, a two year old white boy, was first seen at the Clinic on April 29, 1949. His birth had been uneventful, but on the fourth day following delivery abdominal distention was noted which was relieved by enemas. The child then had six to eight loose watery stools a day for the first six months of life. At about the end of the first year the diarrhea was replaced with obstinate constipation, requiring the aid of high colonic irrigations for evacuation.

Physical examination revealed the boy to be in apparently good health. The abdomen was slightly distended and a putty-like mass filling the right flank was palpable. The rectum was dilated and contained a large fecal impaction. A barium enema revealed a narrowed area in the distal sigmoid which showed little change in the filled colon and evacuation films. The colon proximal to the narrowed area was greatly dilated, particularly in the cecum and ascending. . .



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