Acquired megacolon in Chagas' disease

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Abstract
In this excellent presentation, a report is made of the well-established role of T. cruzi in the etiology of acquired megacolon in South America. The chief difference from the distal aganglionosis of Hirschsprung's disease is that, in acquired megacolon of Chagas' disease, there are degenerative changes and quantitative reduction in the intramural ganglia of the entire intestinal tract. To stimuli, there is a hypersensitive response of the denervated muscle layer which becomes hypertrophic and lacking in propulsive efficiency owing to its in-coordinate contractions (aperistalsis). The result is fecal stasis, dilatation and finally hypoxic atony. Clinical and radiologic features, surgical management, complications and clinical results are presented with clarity. Brief remarks are made concerning removal of various segments of the colon, surgical management of total megacolon and problems relating to acute volvulus of the sigmoid flexure. There were no operative deaths in a series of 100 cases. The actual aim of treatment is correction or palliation of obstipation and although results proved to be good in about 70 per cent of traced patients, the chances of recurrence cannot be predicted because neuronal destruction in the remainder of the intestine is irreversible and the surgeon cannot determine its extent.