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Diagnosis and Treatment of Aganglionosis of the Myenteric Plexus

WILLIAM L. RIKER, M.D.
AMA Arch Surg. 1957;75(3):362-376. doi:10.1001/archsurg.1957.01280150052006.
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One of the most important advances in pediatric surgery during the past 10 years has been the clarification of the etiology of congenital megacolon and the evolution of a satisfactory form of surgical treatment. Many newborn infants who formerly died of "volvulus of the sigmoid," or "locked bowels," have been saved, and hundreds of older children have been freed from a nightmare of laxatives, enemas, and ill health.

The logical, but unfortunate, error of blaming the dilated, hypertrophic segment of bowel for the constipation was gradually erased by the efforts of many investigators until it is generally agreed that the narrow, spastic segment of aganglionosis distal to the dilatation is the cause of the obstruction. The next logical step was to direct the surgical approach to this diseased segment, as was so ably done by Swenson in 1948.17

At the Children's Memorial Hospital 59 patients with congenital megacolon have

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