Psychogenic megacolon in children: a study of its aetiology, clinical features and treatment

Abstract

The object of the present study is to demonstrate that progressive enlargement of the distal bowel may develop in children on a basis of emotional factor -. It is hoped to show that this condition. constitutes a definite clinical entity, distinct from Hirschsprung's disease, and characterised by typical signs and symptoms. Chief among these are chronic, often intractable constipation, resulting loading of the rectum. and terminal colon with retained faeces, and subsequent overflow faecal soiling. Evidence will be adduced to suggest the identity of this disorder with idiopathic megacolon.A series of thirty cases will be presented with the aim of demonstrating how the condition develops, and the reasons for its development. It will be submitted that the importance of the aetiological concept lips in the approach to treatment. Whereas definitive surgery is the treatment of choice for aganglionic megacolon, a surgical approach is not indicated in cases of psychogenic origin; nor are sustained results procured as a rule from purely symptomatic measures of relief.It will be contended that the rational treatment of this disorder depends upon full appraisal of it underlying aetiological basis; and that satisfactory result are achieved only through adequate evaluation and correction of the relevant emotional factors which contribute to the condition.