Hirschsprung´s Disease vs. Normal Anorectum
Right picture: Here, a normal relaxation reflex of the internal sphincter muscle is present which is a part of the normal defecation mechanism. Left picture: A relaxation cannot be induced which is pathognomonic for a congenital megacolon. The so-called achalasia must be considered in the treatment of Hirschsprung´s disease.
Anorectal manometry in 2 schoolchildren with constipation. Imitation of the defecation reflex by sudden expansion of the rectal ampulla with increasing amounts of air from 5 to 20 or to 10 millilitre. Left picture: The distinct waves of the spontaneous muscle activity of the internal sphincter are visible, its activity is not interrupted by the defecation stimulus. Right picture: The insufflation of 5 and 10 millilitre leads to a weak, and thereafter, to a strong interruption of the activity of the internal sphincter muscle which is recognizable by a downward deviation of the recording; afterward, the activity of the internal sphincter muscle becomes more distinctly recognizable.