[Hirschsprung's disease in adolescents and adults]

Megacolon must be considered as a diagnosis in any case of intractable constipation also in the adult. Besides the Hirschsprung's disease and the idiopathic megacolon, which have no apparent organic cause, many other pathologic conditions may produce a marked dilatation of the large bowel. The differential diagnosis depends, after a valuation of the clinical and radiologic features, also from enzymatic, histologic and functional tests. The Hirschsprung's disease can be observed after the infancy in: 1) Patients in whom diagnosis is made only in adult age; 2) Patients with a diagnosis made in infancy or childhood, with moderate symptoms, treated with a conservative methods, who are getting worse; 3) Adult relapsers after a previous inadequate operation. Group II also includes the patients who need an emergency operation, because of a perforation or a volvolus of a dilatated loop. We report three cases of adult Hirschsprung's disease and two adult "idiopathic megacolon". The patients with aganglionic megacolon were admitted to our Hospital respectively for an abdominal palpable mass, a volvolus and incontinence. The two patients with idiopathic megacolon showed the same clinical picture of those with Hirschsprung's disease. We choose a surgical therapy in all five patients, with good long-term results.