MANAGEMENT AND PROGNOSIS OF MEGACOLON (HIRSCHSPRUNG'S DISEASE)

Abstract

Patients with megacolon (Hirschsprung's disease) present difficult problems of management and prognosis. Diet, enemas, laxatives and parasympathomimetic drugs have been the major medical aids. Surgical intervention, when employed, has usually consisted of colostomy, resection of the colon, sympathectomy or emergency correction of a volvulus or perforation. The medical literature is extensive and will not be reviewed. The surgical literature has been reviewed by us in a report dealing with the surgical treatment of obstinate megacolon.¹ The conclusions based on this review are that protracted medical management of obstinate megacolon carries a high mortality, that segmental resection of the colon carries some risk and may be followed by recurrence and that sympathectomy does not alter significantly the gross pathologic condition. Sympathectomy apparently facilitates medical management and, at the same time, decreases or interrupts the impulses over the pathways for visceral pain, which give early warning of impaction, pressure necrosis or