Nonsurgical Test for the Diagnosis of Hirschsprung's Disease

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Abstract
A manometric technic is described for the diagnosis of Hirschsprung's disease without the necessity of deep-muscle rectal biopsy. Separate pressure recordings were obtained from the internal and external anal sphincters by a double balloon device and from the rectum by a third balloon. Simultaneous electromyographic activity was recorded from the external sphincter by a concentric needle electrode. In 34 normal subjects transient distention of the rectal balloon produced reflex relaxation of the internal sphincter (smooth muscle) and contraction of the external sphincter (striated muscle), with a simultaneous increase of electrical activity in the external sphincter. In 10 patients with Hirschsprung's disease, there was contraction of the internal sphincter instead of relaxation. External sphincter responses were normal. In 31 patients with idiopathic megacolon, both internal and external sphincter responses were normal, indicating that the abnormal contractile response found in Hirschsprung's disease is characteristic of this disorder and not of megacolon in general. This contractile response may contribute to obstructive symptoms in Hirschsprung's disease.