AUTONOMIC NERVES IN RECTUM AND COLON IN HIRSCHSPRUNGS DISEASE - A CHOLINESTERASE AND CATECHOLAMINE HISTOCHEMICAL STUDY

The distribution of adrenergic and acetylcholinesterase positive (cholinergic) nerves in the muscle layers of large bowel was studied in resected specimens from 23 young children: 4 normal controls, and 19 cases of Hirschsprung's disease. The number of cholinergic nerves in the circular muscle of the aganglionic bowel in Hirschsprung's disease varied from case to case, but a correlation was found between the number of such nerves and the severity of the disease. The junctional zone between normal and aganglionic bowel, though containing ganglia, was deficient in muscular nerves. The morphological findings are discussed in relation to functional activity in normal and aganglionic bowel, and it is suggested that more than one factor is responsible for the bowel malfunction in Hirschsprung's disease. Aganglionosis results in a failure of co-ordinated contraction and inhibition. Cholinergic muscular nerves are probably responsible for the typically contracted state of the distal bowel. In the junctional zone between normal and aganglionic bowel, the deficiency of muscular nerves probably means that this segment of bowel can exert only a poor propulsive force.