Fioretti G P, Amici G, Parmeggiani P
Minerva Chir. 1978;33(15-16):887-904.
The criteria employed in the classification of megarectum in infancy are briefly reviewed and its diagnosis is discussed. Stress is laid on the importance of clyster radiology and rectal manometry. Biopsy extended to the point of true sphincteromyectomy may also prove resolutive. Lastly, infantile neuropsychiatry is unmistakably indicated in diagnosing the psychological origin of many of these forms. Aganglionic forms are quickly described and attention is directed to those due to fibrosis of the inner sphincter. Most of such cases are shown to be of secondary, reactive, rather than primary congenital, origin on histological inspection after surgery. Lastly, consideration is given to essentially psychogenic forms. The picture observed in a case treated by sphincteromyectomy with histological evidence of interstitial fibrosis with muscle and nerve regression suggested that affective disturbances lead first to persistent constipation, followed by abnormal distension of the last segments of the intestine. Subsequent regression results in an organic evolution independent of the original disturbance, so that surgery must be resorted to, as well as neuropsychiatric treatment.
本文简要回顾了婴儿巨直肠分类所采用的标准，并对其诊断进行了讨论。强调了灌肠造影和直肠测压的重要性。活检延伸至真正的括约肌切除术时也可能具有决定性作用。最后，婴儿神经精神病学在诊断许多此类病症的心理起源方面具有明确的指示作用。对无神经节形式进行了简要描述，并关注了由于内括约肌纤维化导致的情况。经手术组织学检查显示，大多数此类病例是继发性、反应性的，而非原发性先天性起源。最后，考虑了基本为心因性的形式。在一例接受括约肌切除术治疗的病例中观察到的情况，其组织学证据显示存在间质纤维化伴肌肉和神经退行性变，提示情感障碍首先导致持续性便秘，随后是肠道末段异常扩张。随后的退行性变导致了与原始障碍无关的器质性演变，因此必须采取手术以及神经精神病学治疗。
