Transient functional obstruction of the colon in neonates: examination of its development by manometry and biopsies

Between 1975 and 1983, 17 neonates with transient functional obstruction of the colon were studied in our surgical department. Five could be successfully treated conservatively with enemas. In the remaining 12 cases colostomy was necessary. In three cases colostomy was performed too late and the patients died. In the other nine cases rectal biopsies and anorectal manometries were performed repeatedly. In spite of clear radiological signs of colonic obstruction such as in Hirschsprung's disease in each case, and identical clinical signs, true aganglionosis could be excluded. Rectoanal manometry 4 months after colostomy showed that the situation had normalized in five cases, but was still pathological in four cases, as in aganglionosis. Of the rectal biopsies, five showed signs of immaturity of ganglionic cells and three were normal. Rectoanal manometry 12-24 months later showed normal reaction in all cases, and of the five cases with immaturity of the ganglionic cells at 4 months one was still pathologic at 12-24 months. In eight of 12 cases the colostomy was closed without relapse of the obstruction, even on long-term follow up. Aganglionosis of the ultrashort type was excluded. In cases of severe transient functional obstruction of the colon in neonates, in which colostomy is necessary, rectoanal manometry and rectal biopsies should be performed as early as possible. Rectoanal manometry, at least, should be done before closure of the colostomy to avoid relapse of the obstruction from closing it to early: the functional disturbance may persist for several months. The term "small left colon syndrome" should be abandoned in favor of "transient functional obstruction,", as the latter describes the clinical condition far better.