Some new observations on megacolon in infancy and childhood with special reference to the management of megasigmoid and megarectum

New classification of hypoganglionosis: congenital and acquired hypoganglionosis

“…Thereafter, Bentley [9] and Ehrenpreis [10] also described this disease. Recently, Meier-Ruge et al [4] called this category as bisolated formQ of hypoganglionosis and reported 7 children between 6 and 11 years old showing megacolon, meteorism, and temporary subileus symptoms.…”

Role of rectal myomectomy in refractory chronic constipation

“…It was successfully applied to the oesophagus (Heller's cardiomyotomy for achalasia cardia), pylorus (Ramstedt's pyloromyotomy for hypertrophic pyloric stenosis) and small and large intestine (Martin's total colonic myotomy for long-segment HD) in the early part of the last century by various researchers, its role in the anorectal region was proposed and described with successful results by Hurst, [6] Bentley [7] and Thomas. [8] Bentley et al described posterior excisional anorectal myectomy in the management of chronic faecal accumulation.…”

“…[9] Bentley et al also demonstrated that most of the patients with labelled idiopathic megacolon to have an abnormality of the myentric plexus diagnosed on HPE. [5] The division of internal sphincter has been used by Swenson and his associates [14,16] for recurrent symptoms and after proctosigmoidectomy in HD, and has also been used by Bentley (1964) [7] in patients with megarectum.…”

Hirschsprung’s Disease in Adults: the Duhamel Procedure

“…The success of the myectomy depends upon the division of the internal sphincter and circular muscle fibers of the lower aganglionic colon and rectum to overcome the obstructing effect of the tonic circular contraction. The therapeutic effect of this procedure could be compared with the effect of gastro-oesophageal myotomy (Heller's procedure) in patients with achalasia (10). When aganglionosis extends above the pelvis (short segment disease), myectomy of the anorectum and internal sphincter is combined with a low anterior resection.…”