RESUMO
Anorectal motility was studied in 23 patients with adult megacolon. A balloon was used for rectal distension, and electrical signals from the anal canal or rectal mucosa were monitored with a silver/silver chloride electrode. Intraluminal pressure was measured by a pressure transducer linked to the vicinity of the electrode via a polythene tube. Responses to rectal distension provided a means of distinguishing patients with adult Hirschprung's disease from ones with idiopathic megacolon. Some patients with the latter condition showed an elevation of mean anal canal pressure relative to that in normal subjects. There was no statistically significant difference in slow-wave frequency in the anal canal between patients and adult megacolon and normal subjects. The fall in anal canal pressure associated with rectal distension was correlated with a decline in the amplitude of slow-wave electrical activity. The measurement of anorectal motor parameters was of value in the management of adult megacolon.
Assuntos
Canal Anal/fisiopatologia , Motilidade Gastrointestinal , Megacolo/fisiopatologia , Reto/fisiopatologia , Sulfato de Bário , Biópsia , Eletrofisiologia , Enema , Doença de Hirschsprung/diagnóstico , Doença de Hirschsprung/fisiopatologia , Doença de Hirschsprung/terapia , Humanos , Megacolo/diagnóstico , Megacolo/terapia , Pressão , Reto/patologiaRESUMO
Anorectal manometric studies were performed on nine patients with Hirschsprung's disease and ten patients with idiopathic megacolon for the purpose of differentiation, comparing with those of the normal subjects. The anorectal reflex was absent in all nine of the patients with Hirschsprung's disease while in all of ten patients with idiopathic megacolon rectal distension produced a relaxation in the anal canal like that of the normal subjects. Manometric studies proved to be a reliable and non-invasive technique for the diagnosis of Hirschsprung's disease and were of particular value as simple screening tests in patients with a clinical suggestion of this disease. The manometric studies of the patients with Hirschsprung's disease or idiopathic megacolon in the present series also demonstrated that the pronounced internal sphincter contraction combined with a total absence of reflex relaxation or an inadequate response of the sphincter to rectal distension might be responsible for the obstructive symptoms in these diseases.
