AGANGLIONIC AND FUNCTIONAL MEGACOLON IN CHILDREN—A DIAGNOSTIC DILEMMA

Abstract

Megacolon in early infancy and childhood may be due to a number of causes. The proper treatment must necessarily depend upon the accuracy of the diagnosis as to etiology in each patient. We have reviewed our cases of functional megacolon, i.e., "meconium plug syndrome," "acquired constipation," or "colonic inertia" and have encountered examples of unnecessary enterostomy, colostomy and/or pull-through procedures which were performed for what appeared to be congenital aganglionic megacolon. We have also observed numerous examples of prolonged unproductive conservative treatment in patients who were subsequently proven to have aganglionic megacolon. A review of the conventional signs and symptoms and radiographic studies which were carried out on these patients suggests that these observations alone are insufficient to establish a diagnosis and allow for definitive therapy. The full thickness rectal wall biopsy has, by contrast, been an extremely valuable diagnostic aid. At the present time, we do not feel that a definite diagnosis can be established without rectal biopsy which, when properly performed and studied by an experienced pathologist, will differentiate between patients who require major surgery and those who may be expected to respond to conservative medical management.