Abstract
The anorectal resting pressure and defecation sensory pressure were measured in 61 infants and children consisting of 18 with Hirschsprung's disease, 6 with suspected Hirschsprung's disease, 19 with imperforate anus, and 22 controls. The results obtained were as follows : 1) Anorectal reflex was observed in all controls and the patients with suspected Hirschsprung's disease. 2) The reflex was not observed in any of the patients with Hirschsprung's disease. 3) The rectal pressure, anal canal pressure, and pressure difference between rectum and anal canal of the patients with Hirschsprung's disease were similar to those of the controls. The anal canal pressure and pressure difference between rectum and anal canal of the patients with suspected Hirschsprung's disease were higher than those of the controls. 4) Anorectal reflex was observed in 38% of the surgically treated Hirschspung's disease patients. There was no close correlation between clinical improvement and occurrence of the reflex. 5) The rectal pressure of the patients with Hirschsprung's disease measured after operation was hardly different from that obtained before operation. The anal canal pressure and pressure difference between rectum and anal canal of the patients with Hirschsprung's disease taken after operation were lower than those measured before operation; and they were lower in patients who showed excellent clinical improvement than in those who did not. 6) After operation for imperforate anus, anorectal reflex was observed in patients with low anomalies, but not in patients with intermediate or high anomalies. Clinical improvement was excellent in the patients who had postoperative reflex. 7) After operation for imperforate anus, the rectal pressure did not differ according to type of anomaly or clinical results. The anal canal pressure and pressure difference between rectum and anal canal were lower in patients with hign or intermediate anomalies and with poor surgical results. 8) The defecation sensory pressure of the patients with Hirschsprung's disease was similar to that of the controls, and was lower than the pressure difference between rectum and anal canal. (normal relation : defecation sensory pressure<pressure difference between rectum and anal canal.) The defecation sensory pressure of the surgically treated imperforate anus patients was similar to that of the controls except for those with high anomalies. In patients with good surgical results, the sensory pressure was lower than the pressure difference (normal relation). In patients with incontinentia, the sensory pressure was higher than the pressure difference (reversed relation).
