Some observations on the intrinsic nervous mechanism in Hirschsprung's disease.

Both at rest and during transmural stimulation acetylcholine output from isolated longitudinal and circular muscle strips is significantly higher in the spastic segment than in the proximal dilated bowel. No difference has been found in the tissue concentration of acetylcholine between ganglionic and aganglionic specimens. The pattern of response to transmural stimulation is also similar in the spastic and dilated bowel. However, after cholinergic and adrenergic blockade transmural stimulation fails to induce relaxation in aganglionic specimens, as it does in normal colon. The hypotheses are advanced that the increase in acetylcholine output may be partly dependent on a failure of the intrinsic modulating mechanisms and that an alteration of the non-adrenergic inhibitory neurons may be involved in the motor disturbances of the aganglionic tract.