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SYMPATHETIC INHIBITION OF THE LARGE INTESTINE IN HIRSCHSPRUNG'S DISEASE 1

1930; American Society for Clinical Investigation; Volume: 9; Issue: 2 Linguagem: Inglês

10.1172/jci100302

1558-8238

W. J. MERLE SCOTT, John J. Morton,

Intestinal and Peritoneal Adhesions

Physiologists have known for many years that lumbar sympathetic stimulation caused inhibition of motor activity in the colon together with contraction of the internal sphincter ani (1) (2).No direct application of this knowledge to the treatment of Hirschsprung's disease was however attempted until Royle observed marked improvement in the obstinate constipation of spastic paralytic patients after interrupting the lumbar sympathetic connections (3).Hunter studied the problem in the laboratory (4).Their clinical and experimental experiences that improved motor function of an inert colon followed the removal of the sympathetic influence, furnished the basis for testing the effect of a similar procedure in the treatment of congenital idio- pathic dilatation of the colon.This condition had long been sus- pected of having a neurogenic basis (5) (6).But not until the relief of it achieved by Wade and Royle (7) through lumbar sympathetic ramisection, was there any convincing evidence that the extrinsic nervous mechanism of the bowel was etiologically involved.Besides this original case, the results of interrupting the sympathetic pathways to the colon have been recorded in six others of Hirsch- sprung's disease.Wade (8) operated upon four of these patients and Judd and Adson (9) reported two.We are sure that some others have been treated in this way but the results are not available as yet in the literature.In five of the seven cases the results have been eminently successful, while in two they have been unsatisfactory.The failure to obtain uniform results raises the question, in a given case of megalo- colon what effect will be obtained by operative interruption of its sympathetic innervation.Further information concerning the nature