Megacolon in the Newborn.

Abstract

Listen

Translate article

A clinical and röntgenological study of the onset and course in 9 megacolon cases in newborns discloses that the primary genetic factor in the etiology of the disease is a disturbance to the emptying of the bowel The röntgenological megacolon picture is a secondary development to this disturbance, occurring within a varying period of time, which was established in 4 of the cases to be from 3 weeks to 3 1/2 months, while it may be longer or shorter in other cases Redundancy of the colon and, in particular, the sigmoid was not more marked than in normal newborns. Nor was any other obstruction ascertainable The study of these megacolon cases in comparison with normal newborns has revealed the untenability of the arguments which have supported the malformation and obstruction theories: The eases earlier described as megacolon in newborns and infants are either too old to prove the congenital nature of the changes, or too uncertain to reveal their megacolon nature. The abdominal distension soon after birth in cases of megacolon is a manifestation of a disease picture resembling ileus and does not prove the congenital dilatation of the colon The significance attributed to colonic redundancy is based on insufficient knowledge of the normal anatomy of the colon in newborns. The redundant colon in newborns can only to a very slight extent be explained by an actual increase in the length of the colon. It is, no doubt, chiefly due to the fact that the space left to the colon is considerably reduced in newborns by the largeness of the liver and the smallness of the pelvis. This gives rise to a sinuous course of the colon which is the rule in normal newborns and must be considered as physiological with regard to that particular age Thus, megacolon may be characterized as a dilatation and hypertrophy of the colon owing to disturbed evacuation of the bowels. The particular kind of disturbance and the possible existence of a neuro-anatomical substratum have not as yet been elucidated. It is therefore consistent with prevailing terminology to define, for the time being, this disturbance as a functional disorder.